| Choice Providers Medical Group Inc | |
|
17750 Sherman Way Ste 101 Reseda CA 91335-3380 | |
| (818) 705-7200 | |
| (818) 343-0805 |
| Full Name | Choice Providers Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 17750 Sherman Way, Reseda, California |
| Authorized Official Name and Position | Hany Malek (SECRETARY) |
| Authorized Official Contact | 8187057200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Choice Providers Medical Group Inc 17750 Sherman Way Ste 101 Reseda CA 91335-3380 Ph: (818) 705-7200 | Choice Providers Medical Group Inc 17750 Sherman Way Ste 101 Reseda CA 91335-3380 Ph: (818) 705-7200 |
| NPI Number | 1114947058 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 05/29/2008 |
| Medicare PECOS PAC ID | 3476508979 |
|---|---|
| Medicare Enrollment ID | O20050317000511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114947058 | NPI | - | NPPES |
| ZZZ50145Z | Other | CA | BLUE SHEILD (RESEDA) |
| ZZZ50147Z | Other | CA | BLUE SHEILD (INGLEWOOD) |
| ZZZ50174Z | Other | CA | BLUE SHEILD (S.B.) |
| ZZZ50176Z | Other | CA | BLUE SHEILD (C.P) |
| ZZZ501722Z | Other | CA | BLUE SHEILD (G.H.) |
| ZZZ50172Z | Other | CA | BLUE SHEILD (EL MONTE) |
| ZZZ50173Z | Other | CA | BLUE SHEILD (PASADENA) |
| GR0102431 | Medicaid | CA | |
| GR0102433 | Medicaid | CA | |
| ZZZ50146Z | Other | CA | BLUE SHEILD (L.A.) |
| GR0102434 | Medicaid | CA | |
| ZZZ501752 | Other | CA | BLUE SHEILD |
| GR0102430 | Medicaid | CA | |
| GR0102432 | Medicaid | CA |
| Provider Name | Michael M Koshak |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689680696 PECOS PAC ID: 9537187208 Enrollment ID: I20051110000883 |
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