| Imd Medical Group Inc | |
|
1234 N Vermont Ave Los Angeles CA 90029-1704 | |
| (213) 487-6867 | |
| (213) 487-6811 |
| Full Name | Imd Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1234 N Vermont Ave, Los Angeles, California |
| Authorized Official Name and Position | Imad El Asmar (PRESIDENT) |
| Authorized Official Contact | 2134876867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imd Medical Group Inc 1234 N Vermont Ave Los Angeles CA 90029-1704 Ph: (213) 487-6867 | Imd Medical Group Inc 1234 N Vermont Ave Los Angeles CA 90029-1704 Ph: (213) 487-6867 |
| NPI Number | 1508804006 |
|---|---|
| Provider Enumeration Date | 06/04/2006 |
| Last Update Date | 12/10/2015 |
| Medicare PECOS PAC ID | 5991608317 |
|---|---|
| Medicare Enrollment ID | O20040131000174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508804006 | NPI | - | NPPES |
| GR0093890 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A61923 (California) | Primary |
| 261QP2300X | Clinic/center - Primary Care | A89382 (California) | Secondary |
| Provider Name | Imad El Asmar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912956525 PECOS PAC ID: 0143123562 Enrollment ID: I20050718000098 |
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