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General NPI Number Information
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NPI Number | 1740758515
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Entity Type | Organization
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Legal Business Name | GHENTMD
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 05/15/2021
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Provider Practice Location Address
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Address Line | 1434 W ELLIOT RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85233-5157
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Country | US
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Telephone | 651-246-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 1434 W ELLIOT RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85233-5157
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Country | US
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Telephone | 480-935-8855
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Fax | 855-450-1054
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY ASUELIMEN AGHENTA
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Credential | MD
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Telephone | 480-935-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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