Organization
INTEGRATED MEDICAL GROUP
Active
Organization
INTEGRATED MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GONZALEZ (CREDENTIALING CONTACT)
(570) 622-5455
Entity
Organization
Contact information
Practice address
48 TUNNEL RD, SUITE 203, POTTSVILLE, PA 17901-3875
(570) 622-5455
(570) 622-5493
Mailing address
48 TUNNEL RD, SUITE 203, POTTSVILLE, PA 17901-3875
(570) 622-5455
(570) 622-5493
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
04/13/2006
Last updated
04/11/2008
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