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General NPI Number Information
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NPI Number | 1760715262
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE VEIN CENTER PLLC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 8600 E VIA DE VENTURA STE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3324
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Country | US
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Telephone | 480-483-0208
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Fax | 480-905-8346
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Provider Business Mailing Address
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Address Line | 8600 E VIA DE VENTURA STE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3324
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Country | US
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Telephone | 480-483-0208
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Fax | 480-905-8346
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARK W LUNDELL
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Credential | M.D.
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Telephone | 480-483-0208
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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 | 14274
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License Number State | AZ
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