Provider Demographics
NPI:1457545782
Name:PREMIER MEDICAL GROUP, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PREMIER MEDICAL GROUP, PROFESSIONAL CORPORATION
Other - Org Name:MUHAMMAD AKHTAR, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-438-7778
Mailing Address - Street 1:400 WARREN AVE
Mailing Address - Street 2:SUITE 01
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3807
Mailing Address - Country:US
Mailing Address - Phone:401-438-7778
Mailing Address - Fax:401-438-9388
Practice Address - Street 1:400 WARREN AVE
Practice Address - Street 2:SUITE 01
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3807
Practice Address - Country:US
Practice Address - Phone:401-438-7778
Practice Address - Fax:401-438-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09655261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG75456Medicare UPIN