MEDICARE: INTEGRATED PREMIER GROUP IPG

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	208M00000X	Hospitalist Physician	34295	AZ

General Provider Information

NPI Number	:	1497176788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED PREMIER GROUP IPG

Provider Business Mailing Address
First Line	:	PO BOX 17779
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85011-0779
Country	:	US
Telephone Number	:	602-374-7522
Fax Number	:	602-237-6997

Provider Business Practice Location Address
First Line	:	2700 N 3RD ST
Second Line	:	STE 3045
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1129
Country	:	US
Telephone Number	:	602-374-7522
Fax Number	:	602-237-6997

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MHD KUSSAY AL SAMKARI
Credential	:	M.D.
Telephone Number	:	602-374-7522

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	08/21/2014

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