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General NPI Number Information
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NPI Number | 1770961914
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Entity Type | Organization
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Legal Business Name | INTEGRATED PREMIER GROUP SPECIALTY, LLC
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 2075 S COTTONWOOD DR
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City | TEMPE
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State | AZ
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Zip | 85282-3040
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Country | US
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Telephone | 480-718-0568
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Fax | 480-307-6676
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Provider Business Mailing Address
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Address Line | 2075 S COTTONWOOD DR
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City | TEMPE
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State | AZ
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Zip | 85282-3040
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Country | US
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Telephone | 480-718-0568
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Fax | 480-307-6676
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. FERAS ALDAOUD
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Credential | M.D.
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Telephone | 480-718-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 18871
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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