=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902252661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINIMALLY INVASIVE THERAPEUTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2016
-----------------------------------------------------
Last Update Date | 05/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26362 N 168TH AVE
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85387-6812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-759-0290
-----------------------------------------------------
Fax | 602-428-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22219 N 36TH ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-7397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-759-0290
-----------------------------------------------------
Fax | 602-428-7007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER MD
-----------------------------------------------------
Name | DR. AARON R BRAUN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-759-0290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 41013
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------