Provider Demographics
NPI:1912352725
Name:STRIPES MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:STRIPES MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-228-8048
Mailing Address - Street 1:801 N FEDERAL ST
Mailing Address - Street 2:APT 2001
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6316
Mailing Address - Country:US
Mailing Address - Phone:480-228-8048
Mailing Address - Fax:
Practice Address - Street 1:3846 E LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-9130
Practice Address - Country:US
Practice Address - Phone:917-474-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty