Provider Demographics
| NPI: | 1669810784 |
|---|---|
| Name: | INTEGRATED HEALTH GROUP, P.C. |
| Entity type: | Organization |
| Organization Name: | INTEGRATED HEALTH GROUP, P.C. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | HUSSEIN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HURAIBI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 313-565-6782 |
| Mailing Address - Street 1: | 19785 W 12 MILE RD |
| Mailing Address - Street 2: | SUITE 679 |
| Mailing Address - City: | SOUTHFIELD |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 48076-2584 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 248-213-8300 |
| Mailing Address - Fax: | 248-443-0165 |
| Practice Address - Street 1: | 24430 FORD RD |
| Practice Address - Street 2: | SUITE A |
| Practice Address - City: | DEARBORN HEIGHTS |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48127-3280 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 313-565-6782 |
| Practice Address - Fax: | 313-565-6784 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2013-06-11 |
| Last Update Date: | 2013-06-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OP12330 | Medicare PIN |