Healthcare Provider Details

I. General information

NPI: 1881783835
Provider Name (Legal Business Name): CASA GRANDE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E FLORENCE BLVD STE 220
CASA GRANDE AZ
85222-4764
US

IV. Provider business mailing address

1760 E FLORENCE BLVD STE 220
CASA GRANDE AZ
85222-4764
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-2424
  • Fax: 520-836-1932
Mailing address:
  • Phone: 520-836-2424
  • Fax: 520-836-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22601
License Number StateAZ

VIII. Authorized Official

Name: DR. STEVEN IRA SPIESS
Title or Position: OWNER
Credential: MD
Phone: 520-836-2424