MEDICARE: HONORHEALTH MEDICAL GROUP, LLC

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	207Q00000X	Family Medicine Physician	530802	AZ

General Provider Information

NPI Number	:	1386915676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONORHEALTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	STE. 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	623-434-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	34975 N NORTH VALLEY PKWY STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-4029
Country	:	US
Telephone Number	:	623-295-4820
Fax Number	:	623-295-4830

Authorized Official
Title or Position	:	SVP/CEO
Name	:	SAVAS PETRIDES
Credential	:
Telephone Number	:	480-696-4020

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	09/17/2020

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