| |
17750 Sherman Way, Ste 101, Reseda, CA 91335-3380 | |
(818) 705-7200 | |
(818) 343-0805 |
Full Name | |
---|---|
Type | Facility |
Speciality | Family Medicine |
Location | 17750 Sherman Way, Reseda, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1114947058 | NPI | - | NPPES |
ZZZ50145Z | Other | CA | BLUE SHEILD (RESEDA) |
ZZZ50147Z | Other | CA | BLUE SHEILD (INGLEWOOD) |
ZZZ50174Z | Other | CA | BLUE SHEILD (S.B.) |
ZZZ50176Z | Other | CA | BLUE SHEILD (C.P) |
ZZZ501722Z | Other | CA | BLUE SHEILD (G.H.) |
ZZZ50172Z | Other | CA | BLUE SHEILD (EL MONTE) |
ZZZ50173Z | Other | CA | BLUE SHEILD (PASADENA) |
GR0102431 | Medicaid | CA | |
GR0102433 | Medicaid | CA | |
ZZZ50146Z | Other | CA | BLUE SHEILD (L.A.) |
GR0102434 | Medicaid | CA | |
ZZZ501752 | Other | CA | BLUE SHEILD |
GR0102430 | Medicaid | CA | |
GR0102432 | Medicaid | CA |
Provider Name | Michael M Koshak |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1689680696 PECOS PAC ID: 9537187208 Enrollment ID: I20051110000883 |
Mailing Address | Practice Location Address |
---|---|
17750 Sherman Way, Ste 101, Reseda, CA 91335-3380 Ph: (818) 705-7200 | 17750 Sherman Way, Ste 101, Reseda, CA 91335-3380 Ph: (818) 705-7200 |