Provider Demographics
NPI:1114177425
Name:ANNADEL MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ANNADEL MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:IGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-937-6280
Mailing Address - Street 1:1515 E ORANGEWOOD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6824
Mailing Address - Country:US
Mailing Address - Phone:714-449-4800
Mailing Address - Fax:
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-544-6090
Practice Address - Fax:707-544-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty