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General NPI Number Information
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NPI Number | 1275597221
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Entity Type | Organization
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Legal Business Name | EAST VALLEY PEDIATRIC PULMONARY SPECIALISTS, PLLC
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10250 N 92ND ST 308
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4510
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Country | US
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Telephone | 480-614-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 10250 N 92ND ST 308
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4510
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Country | US
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Telephone | 480-614-6655
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KELVIN S PANESAR
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Credential | MD
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Telephone | 480-614-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 26415
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License Number State | AZ
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