Healthcare Provider Details

I. General information

NPI: 1235115866
Provider Name (Legal Business Name): ANTHONY MICHAEL CILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E. ROOSEVELT ST
PHOENIX AZ
85201
US

IV. Provider business mailing address

7503 E. ALMERIA RD
SCOTTSDALE AZ
85257
US

V. Phone/Fax

Practice location:
  • Phone: 214-770-7450
  • Fax:
Mailing address:
  • Phone: 214-770-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34589
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: