Healthcare Provider Details

I. General information

NPI: 1316244080
Provider Name (Legal Business Name): ARIZONA BRAIN AND SPINE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 N SCOTTSDALE RD STE 240
SCOTTSDALE AZ
85254-5111
US

IV. Provider business mailing address

11000 N SCOTTSDALE RD STE 240
SCOTTSDALE AZ
85254-5111
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-2272
  • Fax: 602-266-2927
Mailing address:
  • Phone: 602-266-2272
  • Fax: 602-266-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IGOR RICHARD YUSUPOV
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 602-663-7346