Healthcare Provider Details

I. General information

NPI: 1770970022
Provider Name (Legal Business Name): PHOENIX INSTITUTE OF MICROVASCULAR & PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 E RAINTREE DR STE 400
SCOTTSDALE AZ
85260-7307
US

IV. Provider business mailing address

PO BOX 47548
PHOENIX AZ
85068-7548
US

V. Phone/Fax

Practice location:
  • Phone: 602-331-7811
  • Fax: 602-331-5886
Mailing address:
  • Phone: 602-331-7811
  • Fax: 602-331-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY COZATT
Title or Position: PRACTICE MANAGER
Credential: MBA
Phone: 602-331-7811