Healthcare Provider Details

I. General information

NPI: 1073795571
Provider Name (Legal Business Name): ACCREDITED CENTER FOR DIGESTIVE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 S VAL VISTA DR STE 101A
GILBERT AZ
85295
US

IV. Provider business mailing address

2563 S VAL VISTA DR STE 101A
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-9005
  • Fax: 480-396-9974
Mailing address:
  • Phone: 480-733-0500
  • Fax: 480-396-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJAY M AHLUWALIA
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-733-0500