Healthcare Provider Details

I. General information

NPI: 1851320824
Provider Name (Legal Business Name): INTEGRATED GLOBAL CONCEPTS MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 E CHAPMAN AVE SUITE #240
PLACENTIA CA
92870-5055
US

IV. Provider business mailing address

377 E CHAPMAN AVE SUITE #240
PLACENTIA CA
92870-5055
US

V. Phone/Fax

Practice location:
  • Phone: 714-572-2039
  • Fax: 714-572-3929
Mailing address:
  • Phone: 714-572-2039
  • Fax: 714-572-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberWG63953E
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL B BRENNER
Title or Position: OWNER
Credential: M.D.
Phone: 714-572-2039