Provider Demographics
NPI:1588664502
Name:INTERNAL MEDICINE GROUP INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE GROUP INC
Other - Org Name:MOHAN L BAFNA MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANDASMY
Authorized Official - Middle Name:
Authorized Official - Last Name:UMAPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-439-7766
Mailing Address - Street 1:88 CENTER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2775
Mailing Address - Country:US
Mailing Address - Phone:440-439-7766
Mailing Address - Fax:
Practice Address - Street 1:88 CENTER RD STE 350
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2775
Practice Address - Country:US
Practice Address - Phone:440-439-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCE9289OtherRR MEDICARE
OH2047832Medicaid
OH2047832Medicaid
OH2047832Medicaid