Healthcare Provider Details

I. General information

NPI: 1235543737
Provider Name (Legal Business Name): ARIZONA CARDIOVASCULAR INSTITUTE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20565 N 19TH AVE
PHOENIX AZ
85027-3563
US

IV. Provider business mailing address

20565 N 19TH AVE
PHOENIX AZ
85027-3563
US

V. Phone/Fax

Practice location:
  • Phone: 866-307-3876
  • Fax: 360-838-1219
Mailing address:
  • Phone: 866-307-3876
  • Fax: 360-838-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGG MILLER
Title or Position: SR. VICE PRESIDENT
Credential: MD
Phone: 610-644-8900