Provider Demographics
NPI:1700498359
Name:INTUITIVE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:INTUITIVE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUKONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-986-1003
Mailing Address - Street 1:654 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1078
Mailing Address - Country:US
Mailing Address - Phone:201-986-1003
Mailing Address - Fax:201-649-1864
Practice Address - Street 1:654 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1078
Practice Address - Country:US
Practice Address - Phone:201-986-1003
Practice Address - Fax:201-649-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty