Provider Demographics
NPI:1881870566
Name:INSTITUTE FOR SPECIALIZED MEDICINE,INC
Entity type:Organization
Organization Name:INSTITUTE FOR SPECIALIZED MEDICINE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:858-405-0553
Mailing Address - Street 1:4125 SORRENTO VALLEY BLVD
Mailing Address - Street 2:SUITE A & C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1423
Mailing Address - Country:US
Mailing Address - Phone:858-794-9192
Mailing Address - Fax:858-794-9164
Practice Address - Street 1:4125 SORRENTO VALLEY BLVD
Practice Address - Street 2:SUITE A & C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1423
Practice Address - Country:US
Practice Address - Phone:858-794-9192
Practice Address - Fax:858-794-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-13
Last Update Date:2018-08-22
Deactivation Date:2018-08-15
Deactivation Code:
Reactivation Date:2018-08-22
Provider Licenses
StateLicense IDTaxonomies
CAA62637261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty