Provider Demographics
NPI:1427569581
Name:MTK PRIMARY CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:MTK PRIMARY CARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARI
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-263-8623
Mailing Address - Street 1:1835A S CENTRE CITY PKWY STE 459
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6525
Mailing Address - Country:US
Mailing Address - Phone:619-677-2788
Mailing Address - Fax:619-259-2334
Practice Address - Street 1:1835A S CENTRE CITY PKWY STE 459
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:619-677-2788
Practice Address - Fax:619-259-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty