Healthcare Provider Details

I. General information

NPI: 1114556321
Provider Name (Legal Business Name): ALEXIA TATEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E BANNER GATEWAY DR STE 315
GILBERT AZ
85234-2172
US

IV. Provider business mailing address

2940 E BANNER GATEWAY DR STE 315
GILBERT AZ
85234-2172
US

V. Phone/Fax

Practice location:
  • Phone: 480-543-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number81374
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: