Healthcare Provider Details

I. General information

NPI: 1922361179
Provider Name (Legal Business Name): ARIZONA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N 51ST AVE STE 5
PHOENIX AZ
85031
US

IV. Provider business mailing address

2352 E UNIVERSITY DR. STE D103
PHOENIX AZ
85034
US

V. Phone/Fax

Practice location:
  • Phone: 623-398-1027
  • Fax: 623-398-1028
Mailing address:
  • Phone: 623-398-1027
  • Fax: 623-398-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HETAL C SHAH
Title or Position: OWNER
Credential: M.D.
Phone: 623-398-1027