Healthcare Provider Details

I. General information

NPI: 1306577457
Provider Name (Legal Business Name): SCOTTSDALE OUTPATIENT SURGERY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8994 E DESERT COVE AVE STE B
SCOTTSDALE AZ
85260-7901
US

IV. Provider business mailing address

8994 E DESERT COVE AVE STE B
SCOTTSDALE AZ
85260-7901
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-2040
  • Fax:
Mailing address:
  • Phone: 602-510-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCEL MALEK
Title or Position: MEDICAL DIRECTOR/SOLE MEMBER
Credential: MD
Phone: 480-551-2040