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General NPI Number Information
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NPI Number | 1467401000
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Entity Type | Organization
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Legal Business Name | ICM MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 211 N PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-1412
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Country | US
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Telephone | 310-673-4000
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Fax | 310-673-4001
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Provider Business Mailing Address
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Address Line | PO BOX 1698
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City | INGLEWOOD
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State | CA
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Zip | 90308-1698
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Country | US
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Telephone | 310-673-4000
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Fax | 310-673-4001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMANUEL SIMA
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Credential | M.D.
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Telephone | 310-989-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 2825600
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License Number State | CA
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