Healthcare Provider Details

I. General information

NPI: 1992168785
Provider Name (Legal Business Name): SURGICAL INSTITUTE OF TUCSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S ALVERNON WAY
TUCSON AZ
85711-5351
US

IV. Provider business mailing address

4787 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 520-204-1495
  • Fax: 623-218-1215
Mailing address:
  • Phone: 520-204-1495
  • Fax: 623-218-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMED6545
License Number StateAZ

VIII. Authorized Official

Name: DR. KAI-UWE LEWANDROWSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-204-1495