Healthcare Provider Details

I. General information

NPI: 1417828609
Provider Name (Legal Business Name): PHOENIX UNIFIED SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 230
PHOENIX AZ
85027-9901
US

IV. Provider business mailing address

20333 N 19TH AVE STE 230
PHOENIX AZ
85027-9901
US

V. Phone/Fax

Practice location:
  • Phone: 480-707-9504
  • Fax: 602-581-7764
Mailing address:
  • Phone: 480-707-9504
  • Fax: 602-581-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MAKAYLA WILLIAMS
Title or Position: FRONT OFFICE/BILLING
Credential:
Phone: 480-707-9504