Provider Demographics
NPI:1366455875
Name:MARATHON MEDICAL GROUP INC
Entity type:Organization
Organization Name:MARATHON MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FRISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-282-6934
Mailing Address - Street 1:500 S ANAHEIM HILLS RD
Mailing Address - Street 2:STE 206
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-282-6934
Mailing Address - Fax:714-282-6935
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:STE 206
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-6934
Practice Address - Fax:714-282-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16596Medicaid
G17484Medicare UPIN
CAG16596Medicare UPIN
CAW16596Medicare PIN