Healthcare Provider Details

I. General information

NPI: 1154697605
Provider Name (Legal Business Name): SCOTTSDALE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 N MILLER RD STE 102
SCOTTSDALE AZ
85251-3697
US

IV. Provider business mailing address

4432 N MILLER RD STE 102
SCOTTSDALE AZ
85251-3697
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0008
  • Fax: 480-945-2778
Mailing address:
  • Phone: 480-945-0008
  • Fax: 480-945-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: UCHENDU AZODO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 480-945-0008