Healthcare Provider Details

I. General information

NPI: 1265619373
Provider Name (Legal Business Name): ANTHONY IKECHUKWU ANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD FL 5
MESA AZ
85202-4707
US

IV. Provider business mailing address

2510 W DUNLAP AVE STE 290
PHOENIX AZ
85021-2759
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-7886
  • Fax:
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-789-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40547
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: