Healthcare Provider Details

I. General information

NPI: 1124685532
Provider Name (Legal Business Name): TEAMMD PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N SCOTTSDALE RD STE 120
TEMPE AZ
85281-1556
US

IV. Provider business mailing address

3433 BROADWAY ST NE STE 305
MINNEAPOLIS MN
55413-1795
US

V. Phone/Fax

Practice location:
  • Phone: 480-877-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAY KELLER
Title or Position: MANAGING INDIVIDUAL
Credential:
Phone: 651-324-0266