Provider Demographics
NPI:1790425833
Name:MEDCO HEALTHCARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MEDCO HEALTHCARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-561-0915
Mailing Address - Street 1:355 E RINCON ST STE 217
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1372
Mailing Address - Country:US
Mailing Address - Phone:951-256-4240
Mailing Address - Fax:951-256-4241
Practice Address - Street 1:355 E RINCON ST STE 217
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1372
Practice Address - Country:US
Practice Address - Phone:951-256-4240
Practice Address - Fax:951-256-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty