Healthcare Provider Details

I. General information

NPI: 1689108649
Provider Name (Legal Business Name): ACACIA FOOT AND ANKLE SURGEONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9179 W THUNDERBIRD RD STE 101
PEORIA AZ
85381-4912
US

IV. Provider business mailing address

9179 W THUNDERBIRD RD STE 101
PEORIA AZ
85381-4912
US

V. Phone/Fax

Practice location:
  • Phone: 623-439-2200
  • Fax:
Mailing address:
  • Phone: 623-439-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0793
License Number StateAZ

VIII. Authorized Official

Name: KAVEH PANAHI
Title or Position: OWNER
Credential: DPM
Phone: 623-439-2200