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General NPI Number Information
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NPI Number | 1497176788
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Entity Type | Organization
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Legal Business Name | INTEGRATED PREMIER GROUP IPG
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 2700 N 3RD ST STE 3045
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City | PHOENIX
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State | AZ
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Zip | 85004-1129
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Country | US
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Telephone | 602-374-7522
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Fax | 602-237-6997
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Provider Business Mailing Address
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Address Line | PO BOX 17779
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City | PHOENIX
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State | AZ
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Zip | 85011-0779
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Country | US
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Telephone | 602-374-7522
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Fax | 602-237-6997
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MHD KUSSAY AL SAMKARI
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Credential | M.D.
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Telephone | 602-374-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34295
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License Number State | AZ
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