Healthcare Provider Details

I. General information

NPI: 1639973761
Provider Name (Legal Business Name): PHOENIX METABOLIC HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E THUNDERBIRD TRL
PHOENIX AZ
85042-8370
US

IV. Provider business mailing address

2320 E BASELINE RD STE 148-284
PHOENIX AZ
85042-6962
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-3378
  • Fax:
Mailing address:
  • Phone: 623-243-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAN BROCK ANDERSEN
Title or Position: OWNER
Credential: NP
Phone: 623-243-3378