Provider Demographics
NPI:1740562966
Name:PREFERRED HEALTH MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:PREFERRED HEALTH MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NDUBISI
Authorized Official - Middle Name:G
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-513-9500
Mailing Address - Street 1:37300 DEQUINDRE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3591
Mailing Address - Country:US
Mailing Address - Phone:586-825-2313
Mailing Address - Fax:
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE 107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-513-9500
Practice Address - Fax:480-513-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1070336OtherBUSINESS LICENSE