Provider Demographics
NPI:1942436548
Name:SIGNATURE MEDICAL CLINICS INC
Entity type:Organization
Organization Name:SIGNATURE MEDICAL CLINICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KOWALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:213-212-4310
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 805
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3909
Mailing Address - Country:US
Mailing Address - Phone:213-977-1176
Mailing Address - Fax:213-977-0668
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 805
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-977-1176
Practice Address - Fax:213-977-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty