Provider Demographics
NPI:1568870426
Name:WILMOT PRIMARY CARE GROUP, PLLC
Entity Type:Organization
Organization Name:WILMOT PRIMARY CARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSBIEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-790-1556
Mailing Address - Street 1:603 N WILMOT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2701
Mailing Address - Country:US
Mailing Address - Phone:520-790-1556
Mailing Address - Fax:520-620-9719
Practice Address - Street 1:603 N WILMOT RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2701
Practice Address - Country:US
Practice Address - Phone:520-790-1556
Practice Address - Fax:520-620-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty