MD Medical Group, LLC
Organization Active NPI Internal Medicine Physician · Phoenix, AZ
NPI 1508609017 · NPPES record last updated Jun 13, 2024
Key facts
- NPI
- 1508609017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- MD MEDICAL GROUP, LLC
- Practice address
- 7500 N Dreamy Draw Dr Ste 211a
Phoenix, AZ 85020-4669 - Phone
- (602) 266-9971
- Fax
- (602) 266-9968
- NPI assigned
- Jun 13, 2024
- Organization subpart
- No
Authorized official
- Name
- Mr. Joseph L Furtado, RN
- Title
- Administrator
- Phone
- (602) 266-9971
Practitioners 3
-
Kristina A McKinzie, FNP
-
Diane Marie Olea-del Rio, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240911001190 | AZ | Part B Supplier - Clinic/Group Practice | 3173063658 |
Receives reassigned benefits from 3 practitioners Practice locations: Phoenix, AZ; Scottsdale, AZ |
National Provider Directory
Locations
7500 N Dreamy Draw Dr
Ste 211A
Phoenix, AZ 85020
Phone (602) 878-1783
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
7500 N Dreamy Draw Dr Ste 211a
Phoenix, AZ 85020-4669
Mailing address
7500 N Dreamy Draw Dr Ste 211a
Phoenix, AZ 85020-4669
Phone (602) 266-9971
Other names
- MD Medical Group
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.