Healthcare Provider Details

I. General information

NPI: 1427211804
Provider Name (Legal Business Name): GILBERT CHILDRENS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E BASELINE RD SUITE 108
MESA AZ
85206-4616
US

IV. Provider business mailing address

4540 E BASELINE RD SUITE 108
MESA AZ
85206-4616
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-3880
  • Fax: 480-545-4551
Mailing address:
  • Phone: 480-892-3880
  • Fax: 480-545-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERRI KERIN
Title or Position: BILLING MANAGER
Credential:
Phone: 480-633-3577