Provider Demographics
NPI:1588697387
Name:DIGESTIVE AND LIVER DISEASE SPECIALISTS A MEDICAL GROUP INC
Entity type:Organization
Organization Name:DIGESTIVE AND LIVER DISEASE SPECIALISTS A MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-758-0403
Mailing Address - Street 1:1771 W ROMNEYA DR
Mailing Address - Street 2:STE C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-758-0403
Mailing Address - Fax:714-917-0785
Practice Address - Street 1:4111 MAINE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3307
Practice Address - Country:US
Practice Address - Phone:626-960-3016
Practice Address - Fax:626-960-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W11808AMedicare ID - Type Unspecified