Provider Demographics
NPI:1760853931
Name:UNITED MEDICAL GROUP
Entity Type:Organization
Organization Name:UNITED MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDULKARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUKDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-232-9800
Mailing Address - Street 1:PO BOX 5534
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5534
Mailing Address - Country:US
Mailing Address - Phone:216-472-2730
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:22750 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1574
Practice Address - Country:US
Practice Address - Phone:440-232-9800
Practice Address - Fax:440-226-8765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-14
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144535Medicaid