Healthcare Provider Details

I. General information

NPI: 1659362259
Provider Name (Legal Business Name): KIDS' IMAGING IN THE DESERT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD STE. A-1245
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-1207
  • Fax: 602-546-1264
Mailing address:
  • Phone: 602-546-1207
  • Fax: 602-546-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN CASSELL
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 602-546-1207