Healthcare Provider Details

I. General information

NPI: 1740921394
Provider Name (Legal Business Name): UNITED ADVANCED SPECIALTY CENTERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MILL AVE STE 800
TEMPE AZ
85281-2899
US

IV. Provider business mailing address

PO BOX 5634
CAROL STREAM IL
60197-5634
US

V. Phone/Fax

Practice location:
  • Phone: 888-402-0202
  • Fax: 248-973-1458
Mailing address:
  • Phone: 734-462-0340
  • Fax: 734-462-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MILLER
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 248-331-7908