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General NPI Number Information
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NPI Number | 1104133446
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Entity Type | Organization
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Legal Business Name | POLARIS MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 7301 E 2ND ST SUITE 106
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5600
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Country | US
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Telephone | 858-699-0572
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | SCOTTSDALE
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State | AZ
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Zip | 85252-1598
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Country | US
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Telephone | 858-699-0572
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SONJA WANEBO
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Credential | MD
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Telephone | 858-699-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 42765
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 42765
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License Number State | AZ
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