Provider Demographics
NPI:1669691929
Name:MITCHELL J SPRIT MD
Entity type:Organization
Organization Name:MITCHELL J SPRIT MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELLE
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SPIRT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-551-0082
Mailing Address - Street 1:2080 CENTURY PARK E #1106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-551-0082
Mailing Address - Fax:310-286-0616
Practice Address - Street 1:2080 CENTURY PARK E #1106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-551-0082
Practice Address - Fax:310-286-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG075156207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75156Medicare ID - Type Unspecified
F79918Medicare UPIN