MEDICARE: ENT SPECIALISTS OF ARIZONA, P.C.

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	174400000X	Specialist	3728	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538115662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT SPECIALISTS OF ARIZONA, P.C.

Provider Business Mailing Address
First Line	:	1492 S MILL AVE
Second Line	:	STE. 301
City	:	TEMPE
State	:	AZ
Zip	:	85281-5652
Country	:	US
Telephone Number	:	480-894-5550
Fax Number	:	480-894-9469

Provider Business Practice Location Address
First Line	:	1492 S MILL AVE
Second Line	:	STE. 301
City	:	TEMPE
State	:	AZ
Zip	:	85281-5652
Country	:	US
Telephone Number	:	480-894-5550
Fax Number	:	480-894-9469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID B MENDELSON
Credential	:	D.O.
Telephone Number	:	480-894-5550

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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