Healthcare Provider Details

I. General information

NPI: 1306974217
Provider Name (Legal Business Name): TATUM INTERNAL MEDICINE & ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 E UNION HILLS DR STE #111
PHOENIX AZ
85050-3390
US

IV. Provider business mailing address

4729 E UNION HILLS DR # 111
PHOENIX AZ
85050-3390
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-5444
  • Fax: 602-482-5666
Mailing address:
  • Phone: 602-482-5444
  • Fax: 602-482-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number20889
License Number StateAZ

VIII. Authorized Official

Name: MRS. HEIDI B CARIATI
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 602-482-5444