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General NPI Number Information
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NPI Number | 1164868345
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Entity Type | Organization
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Legal Business Name | SHAD MISSELDINE, INC.
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 7600 N 15TH ST STE 290
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City | PHOENIX
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State | AZ
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Zip | 85020-4336
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Country | US
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Telephone | 602-312-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 N 15TH ST STE 290
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City | PHOENIX
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State | AZ
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Zip | 85020-4336
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Country | US
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Telephone | 602-312-0855
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SHAD STEVEN MISSELDINE
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Credential | MD
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Telephone | 602-312-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 43059
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License Number State | AZ
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