Provider Demographics
NPI:1972695310
Name:GICHON, ELI MICHAEL
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:MICHAEL
Last Name:GICHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 SHERMAN WAY
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3707
Mailing Address - Country:US
Mailing Address - Phone:818-988-1977
Mailing Address - Fax:818-988-1987
Practice Address - Street 1:16500 SHERMAN WAY
Practice Address - Street 2:SUITE A-6
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3707
Practice Address - Country:US
Practice Address - Phone:818-988-1977
Practice Address - Fax:818-988-1987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4722580001Medicare ID - Type Unspecified