Healthcare Provider Details

I. General information

NPI: 1245492719
Provider Name (Legal Business Name): CHANDLER ENDOCRINOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 S DOBSON RD 115
CHANDLER AZ
85224-5602
US

IV. Provider business mailing address

485 S DOBSON RD 115
CHANDLER AZ
85224-5602
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-0350
  • Fax: 480-899-0351
Mailing address:
  • Phone: 480-899-0350
  • Fax: 480-899-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35776
License Number StateAZ

VIII. Authorized Official

Name: LYUBA BELITSKY
Title or Position: PROPRIETOR
Credential: MD
Phone: 480-899-0350