Provider Demographics
NPI:1851320824
Name:INTEGRATED GLOBAL CONCEPTS MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:INTEGRATED GLOBAL CONCEPTS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-572-2039
Mailing Address - Street 1:377 E CHAPMAN AVE
Mailing Address - Street 2:SUITE #240
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5055
Mailing Address - Country:US
Mailing Address - Phone:714-572-2039
Mailing Address - Fax:714-572-3929
Practice Address - Street 1:377 E CHAPMAN AVE
Practice Address - Street 2:SUITE #240
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5055
Practice Address - Country:US
Practice Address - Phone:714-572-2039
Practice Address - Fax:714-572-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWG63953E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086950Medicaid
CABG247ZMedicare PIN
CAGR0086950Medicaid
CAWG63953EMedicare PIN
CAG63953Medicare PIN
CAE89521Medicare UPIN