Healthcare Provider Details

I. General information

NPI: 1063642304
Provider Name (Legal Business Name): ARIZONA ORTHOPAEDIC FOOT & ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 N SCOTTSDALE HEALTHCARE DR STE 280
SCOTTSDALE AZ
85255-4134
US

IV. Provider business mailing address

PO BOX 26205
SCOTTSDALE AZ
85255-0120
US

V. Phone/Fax

Practice location:
  • Phone: 480-473-3668
  • Fax: 480-473-3671
Mailing address:
  • Phone: 480-473-3668
  • Fax: 480-473-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number005096
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL D. CASTRO
Title or Position: OWNER PHYSICIAN
Credential: DO
Phone: 480-473-3668