Provider Demographics
NPI:1598266710
Name:INTEGRATED MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL MANAGEMENT, LLC
Other - Org Name:CHANDLER FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-579-6197
Mailing Address - Street 1:20713 E OCOTILLO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6117
Mailing Address - Country:US
Mailing Address - Phone:480-882-9993
Mailing Address - Fax:480-248-2377
Practice Address - Street 1:20713 E OCOTILLO RD STE 100
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6117
Practice Address - Country:US
Practice Address - Phone:480-882-9993
Practice Address - Fax:480-248-2377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MEDICAL MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-22
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid