MEDICARE: ZION MEDICAL GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	208M00000X	Hospitalist Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184049322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZION MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	PO BOX 11773
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-0013
Country	:	US
Telephone Number	:	480-907-7707
Fax Number	:	480-907-7097

Provider Business Practice Location Address
First Line	:	3800 S ALMA SCHOOL RD
Second Line	:	SUITE 112
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4499
Country	:	US
Telephone Number	:	480-907-7707
Fax Number	:	480-907-7097

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. OBINNA EGBO
Credential	:	M.D.
Telephone Number	:	480-907-7707

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	11/05/2015

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Directions to “ZION MEDICAL GROUP PLLC ” Practice Location

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