Provider Demographics
NPI:1427076009
Name:MEDICUS MD INC
Entity type:Organization
Organization Name:MEDICUS MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENYSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-294-6500
Mailing Address - Street 1:3969 4TH AVE
Mailing Address - Street 2:STE #203
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3165
Mailing Address - Country:US
Mailing Address - Phone:619-294-6500
Mailing Address - Fax:619-294-6505
Practice Address - Street 1:3969 4TH AVE
Practice Address - Street 2:STE #203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3165
Practice Address - Country:US
Practice Address - Phone:619-294-6500
Practice Address - Fax:619-294-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48505261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
F23007Medicare UPIN