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NPI Code Detail

MEDICARE: DESERT VALLEY PRIMARY CARE PHYSICIANS

MEDICARE: DESERT VALLEY PRIMARY CARE PHYSICIANS
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
1207Q00000XFamily Medicine Physician35485AZ

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 : 1982795092
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESERT VALLEY PRIMARY CARE PHYSICIANS
Provider Business Mailing Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-249-4508
Fax Number : 602-249-1614
Provider Business Practice Location Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-249-4508
Fax Number : 602-249-1614
Authorized Official
Title or Position : OWNER
Name : DR. TRICIA KAY CROAKE-ULEMAN
Credential : M.D.
Telephone Number : 602-249-4805
Provider Enumeration Date : 09/27/2006
Last Update Date : 08/22/2020

Similar Medicare Providers

1649350034 — BAOAN GIA LE M.D.
Practice Location Address:
4527 N 27TH AVE
PHOENIX, AZ
85017-3702
Practice Phone: 602-249-4508
Practice Fax: 602-249-1614
1881774156 — DR. ROGER H BAKER D.C.
Practice Location Address:
4527 N 27TH AVE
PHOENIX, AZ
85017-3702
Practice Phone: 602-249-4508
Practice Fax: 602-249-1614
1447321682 — MRS. DEEPA SHAH D.C.
Practice Location Address:
4527 N 27TH AVE
PHOENIX, AZ
85017-3702
Practice Phone: 602-249-4508
Practice Fax: 602-249-1614
1558539858 — 27TH AVE MEDICAL PC
Practice Location Address:
4527 N 27TH AVE
PHOENIX, AZ
85017-3702
Practice Phone: 602-249-4508
Practice Fax: 602-249-1614
1386948552 — ARIZONA ADVANCED AESTHETICS PLLC
Practice Location Address:
4527 N 27TH AVE
PHOENIX, AZ
85017-3702
Practice Phone: 602-249-4508
Practice Fax:
1487022323 — PRIME MEDICAL PAIN MANAGEMENT CENTER
Practice Location Address:
4527 N 27TH AVE
PHOENIX, AZ
85017-3702
Practice Phone: 602-300-4754
Practice Fax: 602-249-1614

Directions to “DESERT VALLEY PRIMARY CARE PHYSICIANS ” Practice Location

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