Provider Demographics
NPI:1215979844
Name:CSE MEDICAL GROUP INC.
Entity type:Organization
Organization Name:CSE MEDICAL GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-497-3744
Mailing Address - Street 1:351 ROLLING OAKS DR
Mailing Address - Street 2:102
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1275
Mailing Address - Country:US
Mailing Address - Phone:805-497-3744
Mailing Address - Fax:805-497-1663
Practice Address - Street 1:351 ROLLING OAKS DR STE 102
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1279
Practice Address - Country:US
Practice Address - Phone:805-497-3744
Practice Address - Fax:805-497-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD1437OtherRAILROAD MEDICARE
CA5339360001Medicare NSC
CAW17960Medicare ID - Type Unspecified