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General NPI Number Information
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NPI Number | 1487155354
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Entity Type | Organization
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Legal Business Name | AZ INTEGRATED NEURO SPINE & PAIN LLC
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 13640 N 99TH AVE STE 100
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City | SUN CITY
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State | AZ
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Zip | 85351-0001
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Country | US
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Telephone | 623-322-5700
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Fax | 866-540-1170
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Provider Business Mailing Address
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Address Line | 13640 N 99TH AVE STE 100
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City | SUN CITY
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State | AZ
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Zip | 85351-0001
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Country | US
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Telephone | 623-322-5700
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Fax | 866-540-1170
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Authorized Official
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Title or Position | MEMBER
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Name | MANINDER S KAHLON
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Credential | MD
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Telephone | 623-322-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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