| Siamak Etehad Md Inc A Medical Corporation | |
|
17075 Devonshire St #100 Northridge CA 91325-1600 | |
| (818) 363-2077 | |
| (818) 363-2055 |
| Full Name | Siamak Etehad Md Inc A Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 17075 Devonshire St, Northridge, California |
| Authorized Official Name and Position | Siamak P Etehad (PRESIDENT) |
| Authorized Official Contact | 8006738185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Siamak Etehad Md Inc A Medical Corporation Po Box 280636 Northridge CA 91328-0636 Ph: (818) 363-2077 | Siamak Etehad Md Inc A Medical Corporation 17075 Devonshire St #100 Northridge CA 91325-1600 Ph: (818) 363-2077 |
| NPI Number | 1043657802 |
|---|---|
| Provider Enumeration Date | 06/03/2013 |
| Last Update Date | 01/04/2014 |
| Medicare PECOS PAC ID | 6406071554 |
|---|---|
| Medicare Enrollment ID | O20140702002303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043657802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Siamak P Etehad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184728479 PECOS PAC ID: 6204097108 Enrollment ID: I20120420000336 |
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