Healthcare Provider Details

I. General information

NPI: 1043136005
Provider Name (Legal Business Name): ADVANCED CARE GASTRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 E VALLE VISTA WAY
PARADISE VALLEY AZ
85253-5152
US

IV. Provider business mailing address

5105 E VALLE VISTA WAY
PARADISE VALLEY AZ
85253-5152
US

V. Phone/Fax

Practice location:
  • Phone: 480-650-2168
  • Fax:
Mailing address:
  • Phone: 480-650-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD NAEEMULLAH KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 480-650-2168