Healthcare Provider Details

I. General information

NPI: 1851135347
Provider Name (Legal Business Name): ARIZONA FOOT AND ANKLE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N TUCSON BLVD STE 15
TUCSON AZ
85716-3406
US

IV. Provider business mailing address

1601 N TUCSON BLVD STE 15
TUCSON AZ
85716-3406
US

V. Phone/Fax

Practice location:
  • Phone: 520-209-1919
  • Fax:
Mailing address:
  • Phone: 520-209-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MOHANAD ELTAHIR
Title or Position: OWNER
Credential: DPM
Phone: 703-501-0283