MEDICARE: GRANDVIEW SURGICAL ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	23204	AZ
2	208600000X	Surgery Physician	23204	AZ

General Provider Information

NPI Number	:	1376507616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDVIEW SURGICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	13629 W CAMINO DEL SOL
Second Line	:	STE 180
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-1405
Country	:	US
Telephone Number	:	623-584-7874
Fax Number	:	623-584-8137

Provider Business Practice Location Address
First Line	:	13629 W CAMINO DEL SOL
Second Line	:	STE 180
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-1405
Country	:	US
Telephone Number	:	623-584-7874
Fax Number	:	623-584-8137

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MITCHELL J GIANGOBBE
Credential	:	M.D.
Telephone Number	:	623-584-7874

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/29/2020

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