Provider Demographics
NPI:1336351709
Name:EDWARD R. SIGALL, M.D., INC.
Entity type:Organization
Organization Name:EDWARD R. SIGALL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-652-9147
Mailing Address - Street 1:99 N LA CIENEGA BLVD
Mailing Address - Street 2:STE 306
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2222
Mailing Address - Country:US
Mailing Address - Phone:310-652-9147
Mailing Address - Fax:310-659-2175
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:STE 306
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-652-9147
Practice Address - Fax:310-659-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB 57879Medicare UPIN