Provider Demographics
NPI:1194022269
Name:IDEAL INTERNAL MEDICINE SOLUTIONS CORPORATION
Entity Type:Organization
Organization Name:IDEAL INTERNAL MEDICINE SOLUTIONS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUZAKEER
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SHAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-235-1079
Mailing Address - Street 1:13035 W VISTA PASEO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5572
Mailing Address - Country:US
Mailing Address - Phone:480-235-1079
Mailing Address - Fax:623-374-3579
Practice Address - Street 1:13035 W VISTA PASEO DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5572
Practice Address - Country:US
Practice Address - Phone:480-235-1079
Practice Address - Fax:623-374-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ143418OtherMEDICARE PTAN