MULTI HEALTH CARE MEDICAL GROUP INC.

Provider Demographics

• NPI: 1861418576
• Name: MULTI HEALTH CARE MEDICAL GROUP INC.
• Entity type: Organization
• Organization Name: MULTI HEALTH CARE MEDICAL GROUP INC.
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: GLENN
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: MARSHAK
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 323-567-8910
• Mailing Address - Street 1: 3175 FIRESTONE BLVD
• Mailing Address - City: SOUTH GATE
• Mailing Address - State: CA
• Mailing Address - Zip Code: 90280-2951
• Mailing Address - Country: US
• Mailing Address - Phone: 323-567-8910
• Mailing Address - Fax: 323-567-8953
• Practice Address - Street 1: 3175 FIRESTONE BLVD
• Practice Address - City: SOUTH GATE
• Practice Address - State: CA
• Practice Address - Zip Code: 90280-2951
• Practice Address - Country: US
• Practice Address - Phone: 323-567-8910
• Practice Address - Fax: 323-567-8953
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-14
• Last Update Date: 2008-02-22

Provider Licenses

State	License ID	Taxonomies
CA	A39722	207V00000X
CA	PT 11601	208100000X
CA	G 23113	207X00000X
CA	A 76527	208800000X
CA	A 35877	207V00000X
CA	PA 17142	363A00000X
CA	E 2963	213E00000X
CA	A48912	207RG0100X
CA	G78454	207R00000X
CA	PA16740	363A00000X
CA	A55940	207Q00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	208800000X	Allopathic & Osteopathic Physicians	Urology		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Multi-Specialty
No	207RG0100X	Allopathic & Osteopathic Physicians	Internal Medicine	Gastroenterology	Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	00A765270	Medicaid
CA	E2963A	Medicaid
CA	GR0092400	Medicaid
CA	C34404	Medicaid
CA	GR0092400	Medicaid
CA	WE2963A	Medicare PIN
CA	WA76527D	Medicare PIN
CA	WG23113C	Medicare PIN