Img Clinic PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IMG CLINIC PLLC

Practice address

3427 Farr Rd Ste B
Fruitport, MI 49415-8854

Phone

(231) 865-7625

NPI assigned

Dec 3, 2021

Last updated

Dec 5, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nazer Abdel-Fattah, DO

Title

Medical Director

Phone

(313) 522-0505

Specialties & licenses 1

Addresses

Tax ID family

County Health Support Services PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• County Health Support Services PLLC

  • Internal Medicine Physician
  • Traverse City, MI
  • NPI 1033876271
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wagdy Tadros, M.D.

  • Internal Medicine Physician
  • Lauderdale Lakes, FL
  • NPI 1114952413
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638662400000",
    "number": "1962160218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 W 11TH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843150",
            "telephone_number": "313-314-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3427 FARR RD STE B",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494158854",
            "telephone_number": "231-865-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMG CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-05",
        "certification_date": "2021-12-05",
        "status": "A",
        "authorized_official_last_name": "ABDEL-FATTAH",
        "authorized_official_first_name": "NAZER",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "313-522-0505",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hackley Community Care Center Inc (Fruitport Middle School)
• Hackley Community Care Center, Inc (Fruitport High School)
• Healthy Concepts Inc. (Fruitport Chiropractic Center)
• Eric Heimendinger
• Veronica Hoyt
• Anthony V Izokaitis, DO
• James Sherrill LLC
• Jessica J Sneller DDS PLLC (Sneller Family Dentistry)
• JKP Pharmacy LLC (Village Pharmacy of Fruitport)
• Zachary Jones, ATC

• Internal Medicine Physician in Fruitport, MI
• Providers in Fruitport, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.