MEDICARE: SURRAJ MEDICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35075	AZ

General Provider Information

NPI Number	:	1316111529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURRAJ MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	5608 E PARADISE LN
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-1202
Country	:	US
Telephone Number	:	623-523-4667
Fax Number	:	623-572-8510

Provider Business Practice Location Address
First Line	:	5608 E PARADISE LN
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-1202
Country	:	US
Telephone Number	:	623-523-4667
Fax Number	:	623-572-8510

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. SHALLU VAID
Credential	:	CPC
Telephone Number	:	623-523-4667

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	05/05/2008

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