Provider Demographics
NPI:1679741110
Name:G & M MANAGEMENT LLC
Entity type:Organization
Organization Name:G & M MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GENNADY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKHONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-653-7566
Mailing Address - Street 1:3566 BEVERLY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4437
Mailing Address - Country:US
Mailing Address - Phone:323-653-7566
Mailing Address - Fax:323-653-5784
Practice Address - Street 1:3566 BEVERLY GLEN BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4437
Practice Address - Country:US
Practice Address - Phone:323-653-7566
Practice Address - Fax:323-653-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG127Medicare PIN