Healthcare Provider Details

I. General information

NPI: 1831630037
Provider Name (Legal Business Name): SAMEER CHOPRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18404 N TATUM BLVD STE 207
PHOENIX AZ
85032-1509
US

IV. Provider business mailing address

18404 N TATUM BLVD STE 207
PHOENIX AZ
85032-1509
US

V. Phone/Fax

Practice location:
  • Phone: 602-777-3113
  • Fax: 602-726-3008
Mailing address:
  • Phone: 602-777-3113
  • Fax: 602-726-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number67829
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD472257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: