MEDICARE: INNLEY MEDICAL GROUP INC.

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	207RP1001X	Pulmonary Disease Physician	A50837	CA

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	:	1770505620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNLEY MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	4253 REDONDO BEACH BLVD
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3341
Country	:	US
Telephone Number	:	310-914-9150
Fax Number	:	310-914-9705

Provider Business Practice Location Address
First Line	:	4253 REDONDO BEACH BLVD
Second Line	:
City	:	LAWNDALE
State	:	CA
Zip	:	90260-3341
Country	:	US
Telephone Number	:	310-914-9150
Fax Number	:	310-914-9705

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	MRS. HAZEL MCKILLOP
Credential	:	M.D.
Telephone Number	:	310-914-9150

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	06/03/2014

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Directions to “INNLEY MEDICAL GROUP INC. ” Practice Location

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