Provider Demographics
NPI:1316018682
Name:MIDTOWN INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:MIDTOWN INTERNAL MEDICINE GROUP
Other - Org Name:MIDTOWN INTERNAL MEDICINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-452-1294
Mailing Address - Street 1:5025 J ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3839
Mailing Address - Country:US
Mailing Address - Phone:916-452-1294
Mailing Address - Fax:916-452-1297
Practice Address - Street 1:5025 J ST
Practice Address - Street 2:SUITE 315
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3839
Practice Address - Country:US
Practice Address - Phone:916-452-1294
Practice Address - Fax:916-452-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089050Medicaid
CAZZZ18889ZMedicare PIN