Provider Demographics
NPI:1215122049
Name:USC ORTHOPAEDIC SURGERY ASSOCIATES, INC.
Entity type:Organization
Organization Name:USC ORTHOPAEDIC SURGERY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-442-5881
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0001
Mailing Address - Country:US
Mailing Address - Phone:323-442-5881
Mailing Address - Fax:323-442-6978
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5881
Practice Address - Fax:323-442-6978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USC ORTHOPAEDIC SURGERY ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71130207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11600AMedicare PIN