Healthcare Provider Details

I. General information

NPI: 1346369253
Provider Name (Legal Business Name): SAN ANTONIO INTERNAL MEDICINE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MCCULLOUGH AVE SUITE 560
SAN ANTONIO TX
78212-5609
US

IV. Provider business mailing address

1303 MCCULLOUGH AVE SUITE 560
SAN ANTONIO TX
78212-5609
US

V. Phone/Fax

Practice location:
  • Phone: 210-223-9617
  • Fax: 210-568-1910
Mailing address:
  • Phone: 210-223-9617
  • Fax: 210-568-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELSA CASAREZ
Title or Position: BUSINESS MANAGER
Credential:
Phone: 210-223-9617