MEDICARE: CAREFREE NEUROLOGY CLINIC PLLC

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	2084N0400X	Neurology Physician		AZ

General Provider Information

NPI Number	:	1316452394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREFREE NEUROLOGY CLINIC PLLC

Provider Business Mailing Address
First Line	:	34406 N 27TH DR STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7730
Country	:	US
Telephone Number	:	602-344-9567
Fax Number	:	602-344-9562

Provider Business Practice Location Address
First Line	:	34406 N 27TH DR STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7730
Country	:	US
Telephone Number	:	602-344-9567
Fax Number	:	602-344-9562

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	FLENY SUSAN VARGHESE
Credential	:	MD
Telephone Number	:	602-344-9567

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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