Healthcare Provider Details

I. General information

NPI: 1730803131
Provider Name (Legal Business Name): SUMMIT RHEUMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 03/07/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 425
GILBERT AZ
85234-0049
US

IV. Provider business mailing address

2451 E BASELINE RD STE 425
GILBERT AZ
85234-0049
US

V. Phone/Fax

Practice location:
  • Phone: 480-494-2770
  • Fax: 480-494-2771
Mailing address:
  • Phone: 480-494-2770
  • Fax: 480-494-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY PANICO
Title or Position: PHYSICIAN
Credential: DO
Phone: 480-442-4262