Organization
ASSOCIATED INTERNAL MEDICINE MED GRP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN J. NICKLES M.D. (PRESIDENT)
(510) 465-6700
Entity
Organization
Contact information
Practice address
100 BAY PL, OAKLAND, CA 94610-4448
(510) 891-8519
(510) 891-8518
Mailing address
350 30TH ST, SUITE 320, OAKLAND, CA 94609-3424
(510) 465-6700
(510) 465-7765
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G84227
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ18981Z
MEDICARE GROUP NUMBER
CA
Enumeration date
12/19/2007
Last updated
01/03/2008
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