Healthcare Provider Details

I. General information

NPI: 1679051171
Provider Name (Legal Business Name): SUPAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 N 94TH DR STE A101
PEORIA AZ
85381-4826
US

IV. Provider business mailing address

13350 N 94TH DR STE A101
PEORIA AZ
85381-4826
US

V. Phone/Fax

Practice location:
  • Phone: 623-933-1010
  • Fax: 623-933-3383
Mailing address:
  • Phone: 623-933-1010
  • Fax: 623-933-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HITPREET SANGHERA
Title or Position: OFFICE MANAGER
Credential: MD
Phone: 623-933-1010