Provider Demographics
NPI:1497176788
Name:INTEGRATED PREMIER GROUP IPG
Entity Type:Organization
Organization Name:INTEGRATED PREMIER GROUP IPG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MHD KUSSAY
Authorized Official - Middle Name:AL
Authorized Official - Last Name:SAMKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-374-7522
Mailing Address - Street 1:PO BOX 17779
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-0779
Mailing Address - Country:US
Mailing Address - Phone:602-374-7522
Mailing Address - Fax:602-237-6997
Practice Address - Street 1:2700 N 3RD ST
Practice Address - Street 2:STE 3045
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1129
Practice Address - Country:US
Practice Address - Phone:602-374-7522
Practice Address - Fax:602-237-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34295208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty