Provider Demographics
NPI:1831595024
Name:SUMMIT MEDICAL GROUP
Entity type:Organization
Organization Name:SUMMIT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GHALIB
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-529-2330
Mailing Address - Street 1:27702 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE D4-113
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0608
Mailing Address - Country:US
Mailing Address - Phone:949-529-2330
Mailing Address - Fax:866-800-5276
Practice Address - Street 1:27702 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE D4-113
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0608
Practice Address - Country:US
Practice Address - Phone:949-529-2330
Practice Address - Fax:866-800-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty