Provider Demographics
NPI:1528458486
Name:OPTUM MEDICAL SERVICES OF CALIFORNIA, P.C.
Entity type:Organization
Organization Name:OPTUM MEDICAL SERVICES OF CALIFORNIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITTELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-632-5372
Mailing Address - Street 1:13625 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-2252
Mailing Address - Country:US
Mailing Address - Phone:615-224-5440
Mailing Address - Fax:
Practice Address - Street 1:13625 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2252
Practice Address - Country:US
Practice Address - Phone:615-224-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty