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General NPI Number Information
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NPI Number | 1467653147
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Entity Type | Organization
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Legal Business Name | ACCESS2CARE FAMILY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 4607 N 12TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-4006
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Country | US
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Telephone | 602-690-0510
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 N 12TH ST
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City | PHOENIX
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State | AZ
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Zip | 85014-4006
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Country | US
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Telephone | 602-690-0510
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLU ONISILE
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Credential | MD
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Telephone | 602-690-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23710
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License Number State | AZ
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