MEDICARE: INNOVATION SURGERY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A101690	CA

General Provider Information

NPI Number	:	1215302393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATION SURGERY INC.

Provider Business Mailing Address
First Line	:	19671 BEACH BLVD
Second Line	:	SUITE 300
City	:	HUNINGTON BEACH
State	:	CA
Zip	:	92648
Country	:	US
Telephone Number	:	949-701-6606
Fax Number	:	949-681-8144

Provider Business Practice Location Address
First Line	:	50 DEER TRAK
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-8812
Country	:	US
Telephone Number	:	949-701-6606
Fax Number	:	949-681-8144

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ATIF IQBAL
Credential	:	MD
Telephone Number	:	949-701-6606

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “INNOVATION SURGERY INC. ” Practice Location

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