Healthcare Provider Details

I. General information

NPI: 1053939066
Provider Name (Legal Business Name): ACE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 E SOUTHERN AVE STE 104
MESA AZ
85206-3628
US

IV. Provider business mailing address

5233 E SOUTHERN AVE STE 103
MESA AZ
85206-3628
US

V. Phone/Fax

Practice location:
  • Phone: 480-567-5267
  • Fax:
Mailing address:
  • Phone: 480-888-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A ZITNIK
Title or Position: MEMBER
Credential: DC
Phone: 480-567-5267