Healthcare Provider Details

I. General information

NPI: 1437681129
Provider Name (Legal Business Name): MAIAN PEDIATRICS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30012 N CAVE CREEK RD SUITE #101
CAVE CREEK AZ
85331-5833
US

IV. Provider business mailing address

30012 N CAVE CREEK RD SUITE #101
CAVE CREEK AZ
85331-5833
US

V. Phone/Fax

Practice location:
  • Phone: 480-528-6502
  • Fax:
Mailing address:
  • Phone: 480-912-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35463
License Number StateAZ

VIII. Authorized Official

Name: THOMAS DONALD ERSKINE
Title or Position: MEMBER/MANAGER
Credential: M.D.
Phone: 305-804-0320