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General NPI Number Information
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NPI Number | 1346718582
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Entity Type | Organization
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Legal Business Name | IVY LEAGUE ANESTHESIA PLLC
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 7878 N 16TH ST STE 250
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City | PHOENIX
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State | AZ
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Zip | 85020-4478
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Country | US
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Telephone | 602-308-7802
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Fax |
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Provider Business Mailing Address
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Address Line | 7878 N 16TH ST STE 250
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City | PHOENIX
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State | AZ
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Zip | 85020-4478
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Country | US
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Telephone | 602-308-7802
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SAMEH ASSAD
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Credential | MD
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Telephone | 602-405-9985
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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 |
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License Number State |
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