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General NPI Number Information
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NPI Number | 1922361179
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Entity Type | Organization
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Legal Business Name | ARIZONA MEDICAL GROUP
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 4700 N 51ST AVE STE 5
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City | PHOENIX
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State | AZ
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Zip | 85031
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Country | US
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Telephone | 623-398-1027
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Fax | 623-398-1028
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Provider Business Mailing Address
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Address Line | 2352 E UNIVERSITY DR. STE D103
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City | PHOENIX
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State | AZ
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Zip | 85034
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Country | US
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Telephone | 623-398-1027
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Fax | 623-398-1028
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Authorized Official
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Title or Position | OWNER
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Name | DR. HETAL C SHAH
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Credential | M.D.
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Telephone | 623-398-1027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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