Provider Demographics
NPI:1215428768
Name:DR. MARK M. GHALILI DO INC
Entity type:Organization
Organization Name:DR. MARK M. GHALILI DO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-437-7836
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 518
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3111
Mailing Address - Country:US
Mailing Address - Phone:855-437-7836
Mailing Address - Fax:800-983-4902
Practice Address - Street 1:8500 WILSHIRE BLVD STE 518
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3111
Practice Address - Country:US
Practice Address - Phone:855-437-7836
Practice Address - Fax:800-983-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty