Healthcare Provider Details

I. General information

NPI: 1184126344
Provider Name (Legal Business Name): CITY OF HOPE MEDICAL GROUP OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 N 90TH ST STE A105
SCOTTSDALE AZ
85258-5046
US

IV. Provider business mailing address

6897 PAYSPHERE CIRCLE
CHICAGO IL
60674-6897
US

V. Phone/Fax

Practice location:
  • Phone: 847-746-4333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI BETH CARMEAN
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 909-803-4400