Provider Demographics
NPI:1912396300
Name:IONE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:IONE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:213-384-5550
Mailing Address - Street 1:3435 WILSHIRE BLVD
Mailing Address - Street 2:500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1901
Mailing Address - Country:US
Mailing Address - Phone:213-384-5550
Mailing Address - Fax:213-384-5558
Practice Address - Street 1:3435 WILSHIRE BLVD
Practice Address - Street 2:500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1901
Practice Address - Country:US
Practice Address - Phone:213-384-5550
Practice Address - Fax:213-384-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5391208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty