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General NPI Number Information
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NPI Number | 1083999361
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Entity Type | Organization
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Legal Business Name | ARIZONA VEIN AND VASCULAR CENTER LLC
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 15571 N REEMS RD
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City | SURPRISE
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State | AZ
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Zip | 85374-9584
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Country | US
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Telephone | 623-214-9235
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Fax | 623-321-1965
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Provider Business Mailing Address
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Address Line | PO BOX 504652
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City | SAINT LOUIS
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State | MO
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Zip | 63150-4652
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Country | US
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Telephone | 623-214-9235
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Fax | 623-321-1965
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Authorized Official
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Title or Position | OWNER
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Name | LIMOR PHILIPP WALL
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Credential | MD
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Telephone | 480-652-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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