Individual
DR. WAYNE STUART GRADMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
235 S MCCARTY DR, BEVERLY HILLS, CA 90212-3701
(424) 653-8560
(310) 277-5045
Mailing address
235 S MCCARTY DR, BEVERLY HILLS, CA 90212-3701
(424) 653-8560
(310) 277-5045
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G17696
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G176960
MEDI-CAL PROVIDER NUMBER
CA
01
—
WG17696D
MEDICARE PERFORMING PROV
CA
Enumeration date
08/29/2006
Last updated
12/22/2022
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