MEDICARE: IRVINE INTERNAL 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	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DH1588	OTHER	CA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1952355315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRVINE INTERNAL MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 575
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-0575
Country	:	US
Telephone Number	:	657-241-3600
Fax Number	:	657-241-7708

Provider Business Practice Location Address
First Line	:	22 ODYSSEY STE 140
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-3193
Country	:	US
Telephone Number	:	949-653-5810
Fax Number	:	949-653-1129

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMAD M MIKHAIL
Credential	:	MD
Telephone Number	:	949-653-5810

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/18/2023

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Directions to “IRVINE INTERNAL MEDICAL GROUP, INC. ” Practice Location

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