Provider Demographics
NPI:1124543129
Name:UNIVERSAL MULTI SPECIALTY MEDICAL GROUP INC
Entity type:Organization
Organization Name:UNIVERSAL MULTI SPECIALTY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-391-4138
Mailing Address - Street 1:1650 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5824
Mailing Address - Country:US
Mailing Address - Phone:909-391-4138
Mailing Address - Fax:909-391-4395
Practice Address - Street 1:1650 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5824
Practice Address - Country:US
Practice Address - Phone:909-391-4138
Practice Address - Fax:909-391-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty