Healthcare Provider Details

I. General information

NPI: 1063933851
Provider Name (Legal Business Name): ANANDBIR S BATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 W PALM LN STE 150
PHOENIX AZ
85037-4454
US

IV. Provider business mailing address

9520 W PALM LN STE 150
PHOENIX AZ
85037-4454
US

V. Phone/Fax

Practice location:
  • Phone: 602-584-5444
  • Fax: 602-584-6202
Mailing address:
  • Phone: 602-584-5444
  • Fax: 602-584-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number71455
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number71455
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: