MEDICARE: SONORAN VEIN AND ENDOVASCULAR 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	2086S0129X	Vascular Surgery Physician

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	:	1790049617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN VEIN AND ENDOVASCULAR LLC

Provider Business Mailing Address
First Line	:	9192 W UNION HILLS DR STE 100
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8209
Country	:	US
Telephone Number	:	602-374-4101
Fax Number	:	602-441-0522

Provider Business Practice Location Address
First Line	:	9192 W UNION HILLS DR STE 100
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8209
Country	:	US
Telephone Number	:	602-374-4101
Fax Number	:	602-441-0522

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID J NYE
Credential	:	DO
Telephone Number	:	803-637-7784

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	01/28/2026

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