Provider Demographics
NPI:1053783258
Name:MICHAEL F. SEDRAK, M.D., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL F. SEDRAK, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FAYEZ
Authorized Official - Last Name:SEDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-728-0494
Mailing Address - Street 1:10336 WILSHIRE BLVD APT 602
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4754
Mailing Address - Country:US
Mailing Address - Phone:310-728-0494
Mailing Address - Fax:619-209-7888
Practice Address - Street 1:10336 WILSHIRE BLVD APT 602
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4754
Practice Address - Country:US
Practice Address - Phone:310-728-0494
Practice Address - Fax:619-209-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82582208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty