Individual provider Active NPI

Stewart Howard Gleischman, MD

  • Surgery Physician
  • La, CA
National Provider Identifier
1225032774
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
G42402 Issued in CA
Practice address
5757 Wilshire Blvd.
#6
La, CA 90036
Phone
(310) 657-6993
NPI assigned
Jun 10, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X G42402 CA Primary

Addresses

Primary practice location

5757 Wilshire Blvd.
#6
La, CA 90036

Mailing address

985 S Carmelina Ave
Los Angeles, CA 90049-5807
Phone (310) 657-6993

Other identifiers 1

IdentifierTypeStateIssuer
00G424020OtherCAMEDI CAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42402CAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225032774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 S CARMELINA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495807",
            "telephone_number": "310-657-6993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 WILSHIRE BLVD.",
            "address_2": "#6",
            "city": "LA",
            "state": "CA",
            "postal_code": "90036",
            "telephone_number": "310-657-6993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLEISCHMAN",
        "first_name": "STEWART",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G42402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL",
            "identifier": "00G424020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.