Provider Demographics
NPI:1750431342
Name:MD ORTHOPEDICS, INC.
Entity type:Organization
Organization Name:MD ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVOODIFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-305-3838
Mailing Address - Street 1:PO BOX 6430
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-6430
Mailing Address - Country:US
Mailing Address - Phone:818-305-3838
Mailing Address - Fax:818-305-3839
Practice Address - Street 1:13833 VENTURA BLVD # 206
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3628
Practice Address - Country:US
Practice Address - Phone:818-305-3838
Practice Address - Fax:818-305-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103428332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1320700001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #