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General NPI Number Information
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NPI Number | 1982466868
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Entity Type | Organization
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Legal Business Name | SUMMIT PROVIDERS GROUP
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 14919 E CAVEDALE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-7899
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Country | US
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Telephone | 480-335-2859
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6134
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City | CHANDLER
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State | AZ
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Zip | 85246-6134
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Country | US
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Telephone | 480-335-2859
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL GOLDMAN
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Credential |
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Telephone | 480-335-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) 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 | 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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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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