Healthcare Provider Details

I. General information

NPI: 1487155354
Provider Name (Legal Business Name): AZ INTEGRATED NEURO SPINE & PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N 99TH AVE STE 100
SUN CITY AZ
85351-0001
US

IV. Provider business mailing address

13640 N 99TH AVE STE 100
SUN CITY AZ
85351-0001
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5700
  • Fax: 866-540-1170
Mailing address:
  • Phone: 623-322-5700
  • Fax: 866-540-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MANINDER S KAHLON
Title or Position: MEMBER
Credential: MD
Phone: 623-322-5700