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General NPI Number Information
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NPI Number | 1316111529
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Entity Type | Organization
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Legal Business Name | SURRAJ MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 5608 E PARADISE LN
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1202
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Country | US
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Telephone | 623-523-4667
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Fax | 623-572-8510
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Provider Business Mailing Address
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Address Line | 5608 E PARADISE LN
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1202
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Country | US
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Telephone | 623-523-4667
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Fax | 623-572-8510
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SHALLU VAID
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Credential | CPC
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Telephone | 623-523-4667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35075
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License Number State | AZ
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