Healthcare Provider Details

I. General information

NPI: 1013612506
Provider Name (Legal Business Name): ARIZONA CARDIOVASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13943 N 91ST AVE STE A101
PEORIA AZ
85381-3688
US

IV. Provider business mailing address

PO BOX 6299
PEORIA AZ
85385-6299
US

V. Phone/Fax

Practice location:
  • Phone: 602-654-1950
  • Fax: 602-848-4880
Mailing address:
  • Phone: 602-654-1950
  • Fax: 602-848-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KISHLAY ANAND
Title or Position: OWNER
Credential: MD
Phone: 602-654-1950