Provider Demographics
NPI:1720130263
Name:IES MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:IES MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:BINMOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-600-1151
Mailing Address - Street 1:DEPT 34754
Mailing Address - Street 2:PO BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:415-600-1151
Mailing Address - Fax:415-447-6330
Practice Address - Street 1:1101 VAN NESS AVE RM 31583D
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6919
Practice Address - Country:US
Practice Address - Phone:415-600-1151
Practice Address - Fax:415-447-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA497670207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851321715OtherDR B NPI
CAA049767OtherDR. B MD LIC CAL
CAG76556OtherDR. S MD LIC CAL