Organization
BAYSIDE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BUDD NORMAN SHENKIN MD (OWNER/PRESIDENT)
(925) 587-2505
Entity
Organization
Contact information
Practice address
5720 STONERIDGE MALL RD, SUITE 240, PLEASANTON, CA 94588-2828
(925) 463-1234
(925) 463-9599
Mailing address
11875 DUBLIN BLVD, SUITE C140, DUBLIN, CA 94568-2843
(925) 587-2505
(925) 587-2511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ06346Z
MEDICARE
CA
Enumeration date
03/22/2006
Last updated
06/04/2010
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