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General NPI Number Information
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NPI Number | 1447472683
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Entity Type | Organization
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Legal Business Name | PANDA MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 6760 W THUNDERBIRD RD STE E100
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City | PEORIA
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State | AZ
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Zip | 85381-5048
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Country | US
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Telephone | 623-241-9028
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Fax | 623-241-9029
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Provider Business Mailing Address
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Address Line | 6760 W THUNDERBIRD RD STE E100
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City | PEORIA
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State | AZ
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Zip | 85381-5048
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Country | US
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Telephone | 623-241-9028
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Fax | 623-241-9029
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHIOMA N IWEHA
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Credential | M.D.
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Telephone | 623-241-9028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26965
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License Number State | AZ
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