| St. Luke Medical Clinic | |
|
5912 Santa Monica Blvd Los Angeles CA 90038-2043 | |
| (323) 461-3888 | |
| (323) 461-3250 |
| Full Name | St. Luke Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 5912 Santa Monica Blvd, Los Angeles, California |
| Authorized Official Name and Position | Nabil F Khalil (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3234613888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Luke Medical Clinic 5912 Santa Monica Blvd Los Angeles CA 90038-2043 Ph: (323) 461-3888 | St. Luke Medical Clinic 5912 Santa Monica Blvd Los Angeles CA 90038-2043 Ph: (323) 461-3888 |
| NPI Number | 1487832655 |
|---|---|
| Provider Enumeration Date | 02/09/2008 |
| Last Update Date | 03/22/2010 |
| Medicare PECOS PAC ID | 2860525813 |
|---|---|
| Medicare Enrollment ID | O20100728000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487832655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | GR008540 (California) | Primary |
| Provider Name | Ira K Grove |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1659327112 PECOS PAC ID: 1052303526 Enrollment ID: I20040402000585 |
| Provider Name | Paula Lynn Bailey-walton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174646590 PECOS PAC ID: 2567497183 Enrollment ID: I20051003000723 |
| Provider Name | Amir H Rad |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1710262472 PECOS PAC ID: 5496911877 Enrollment ID: I20120730000784 |
| Provider Name | Nicholas A Rogers |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124203583 PECOS PAC ID: 7618128778 Enrollment ID: I20121119000438 |
| Provider Name | Nicola F Azar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922259787 PECOS PAC ID: 5799836557 Enrollment ID: I20141124000665 |
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