Provider Demographics
NPI:1134438146
Name:COMMUNITY MEDICAL GROUP INC
Entity type:Organization
Organization Name:COMMUNITY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISHAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-525-6703
Mailing Address - Street 1:9477 N TERRITORIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-8583
Mailing Address - Country:US
Mailing Address - Phone:734-525-6703
Mailing Address - Fax:
Practice Address - Street 1:9477 N TERRITORIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-8583
Practice Address - Country:US
Practice Address - Phone:734-525-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty