Mickey M Kolodny, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G47101 Issued in CA

Practice address

4650 Lincoln Blvd
Marina del Rey, CA 90292

Phone

(310) 823-8911

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beach Cities Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Marina del Rey, CA
  • NPI 1245335991
  NPD (past)
• Gardena Emergency Medical Associates Inc

  • Emergency Medicine Physician
  • Gardena, CA
  • NPI 1497824189
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1750464707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10550",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926850550",
            "telephone_number": "562-809-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 LINCOLN BLVD",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "90292",
            "telephone_number": "310-823-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLODNY",
        "first_name": "MICKEY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G47101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G471010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cergei Walter Klishevich, D.C.
• KLM Surgical Associates
• Eric J Klostermann, D.P.M.
• Kobayashi Optometric Inc
• Susan Kohler, MSCCCSLP
• Nataliia Komashko
• Konviser Dental Professional Corporation
• Konviser Dental Professional Corporation
• Myriam Liberty Koppelmann
• Jeremy E Korman, M.D.

• Emergency Medicine Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.