Provider Demographics
NPI: | 1669810784 |
---|---|
Name: | INTEGRATED HEALTH GROUP, P.C. |
Entity type: | Organization |
Organization Name: | INTEGRATED HEALTH GROUP, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HUSSEIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HURAIBI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 313-565-6782 |
Mailing Address - Street 1: | 19785 W 12 MILE RD |
Mailing Address - Street 2: | SUITE 679 |
Mailing Address - City: | SOUTHFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48076-2584 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-213-8300 |
Mailing Address - Fax: | 248-443-0165 |
Practice Address - Street 1: | 24430 FORD RD |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | DEARBORN HEIGHTS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48127-3280 |
Practice Address - Country: | US |
Practice Address - Phone: | 313-565-6782 |
Practice Address - Fax: | 313-565-6784 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-06-11 |
Last Update Date: | 2013-06-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OP12330 | Medicare PIN |