1144562083 NPI number — INTEGRATED HEALTH GROUP, P.C.

Table of content: (NPI 1144562083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144562083 NPI number — INTEGRATED HEALTH GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH GROUP, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTEGRATED PHYSICAL THERAPY CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144562083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19785 W 12 MILE RD
Provider Second Line Business Mailing Address:
SUITE 679
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-514-2342
Provider Business Mailing Address Fax Number:
248-443-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 GREENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-624-9470
Provider Business Practice Location Address Fax Number:
313-624-9471
Provider Enumeration Date:
03/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HURAIBI
Authorized Official First Name:
HUSSEIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-565-6782

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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