Healthcare Provider Details

I. General information

NPI: 1023229408
Provider Name (Legal Business Name): ANIL BELLUR SEETHARAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9767 N 91ST ST STE 100
SCOTTSDALE AZ
85258-5086
US

IV. Provider business mailing address

3020 E CAMELBACK RD STE 301
PHOENIX AZ
85016-4418
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-1990
  • Fax: 480-860-1687
Mailing address:
  • Phone: 602-521-5800
  • Fax: 602-521-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number46305
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number46305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: