Healthcare Provider Details

I. General information

NPI: 1417586181
Provider Name (Legal Business Name): VITALITY MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16165 N 83RD AVE STE 200
PEORIA AZ
85382-5816
US

IV. Provider business mailing address

16165 N 83RD AVE STE 200
PEORIA AZ
85382-5816
US

V. Phone/Fax

Practice location:
  • Phone: 305-987-4479
  • Fax:
Mailing address:
  • Phone: 305-987-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SARKEES
Title or Position: OWNER
Credential: MD
Phone: 305-987-4479