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NPI Code Detail

MEDICARE: DILLIAN LA SALLE M.D.

MEDICARE:   DILLIAN  LA SALLE  M.D.
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
1207R00000XInternal Medicine Physician25273AZ

Other Identifiers

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

General Provider Information

NPI Number : 1659307569
Entity Type Code : Individual
Provider Name (Legal Business Name) : DILLIAN LA SALLE M.D.
Provider Business Mailing Address
First Line : 1010 E MCDOWELL RD
Second Line : STE 300
City : PHOENIX
State : AZ
Zip : 85006-2609
Country : US
Telephone Number : 602-251-3122
Fax Number : 602-254-1226
Provider Business Practice Location Address
First Line : 1010 E MCDOWELL RD
Second Line : STE 300
City : PHOENIX
State : AZ
Zip : 85006-2609
Country : US
Telephone Number : 602-251-3122
Fax Number : 602-254-1226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 12/20/2024

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Directions to “ DILLIAN LA SALLE M.D.” Practice Location

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