Healthcare Provider Details

I. General information

NPI: 1700883733
Provider Name (Legal Business Name): MD MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7585 N CEDAR AVE SUITE 102
FRESNO CA
93720-2604
US

IV. Provider business mailing address

7585 N CEDAR AVE SUITE 102
FRESNO CA
93720-2604
US

V. Phone/Fax

Practice location:
  • Phone: 559-243-1232
  • Fax: 559-243-9954
Mailing address:
  • Phone: 559-243-1232
  • Fax: 559-243-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA66769
License Number StateCA

VIII. Authorized Official

Name: DR. ABBAS MEHDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-243-1232