Healthcare Provider Details

I. General information

NPI: 1932581766
Provider Name (Legal Business Name): 6730 W CAMELBACK ROAD LLC DBA INSTANTMED HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 N 67TH AVE
GLENDALE AZ
85303
US

IV. Provider business mailing address

5104 N 67TH AVE
GLENDALE AZ
85303
US

V. Phone/Fax

Practice location:
  • Phone: 602-899-4404
  • Fax: 602-899-4408
Mailing address:
  • Phone: 602-899-4404
  • Fax: 602-899-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJIV SIDDARAMU
Title or Position: DIRECTOR
Credential: M.D.
Phone: 602-899-4404