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General NPI Number Information
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NPI Number | 1417283953
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Entity Type | Organization
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Legal Business Name | MEDIC AZ QUALITY
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Dates
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Enumeration Date | 10/18/2009
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Last Update Date | 10/18/2009
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Provider Practice Location Address
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Address Line | 11330 KNIGHTSBRIDGE LN
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City | FISHERS
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State | IN
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Zip | 46037-9151
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Country | US
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Telephone | 317-410-2868
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Fax | 317-578-3638
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Provider Business Mailing Address
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Address Line | 11330 KNIGHTSBRIDGE LN
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City | FISHERS
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State | IN
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Zip | 46037-9151
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Country | US
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Telephone | 317-410-2868
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Fax | 317-578-3638
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Authorized Official
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Title or Position | MANAGER
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Name | GAMAL RAMADAN ELSAYED
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Credential | DSC
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Telephone | 317-410-2858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05004402A
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License Number State | IN
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