Provider Demographics
NPI:1528074614
Name:LITWIN, MICHAEL MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MANUEL
Last Name:LITWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 WILSHIRE BLVD
Mailing Address - Street 2:NO 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4651
Mailing Address - Country:US
Mailing Address - Phone:310-441-9945
Mailing Address - Fax:
Practice Address - Street 1:10430 WILSHIRE BLVD
Practice Address - Street 2:NO 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4651
Practice Address - Country:US
Practice Address - Phone:310-441-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG118562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG11856OtherMEDICAL LIC. NO.
CAA38464Medicare UPIN
CAG11856OtherMEDICAL LIC. NO.