MEDICARE: SEASONS MEDICAL GROUP OF ARIZONA, 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician		AZ

General Provider Information

NPI Number	:	1497001218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS MEDICAL GROUP OF ARIZONA, PC

Provider Business Mailing Address
First Line	:	6400 SHAFER CT STE 300A
Second Line	:
City	:	ROSEMONT
State	:	IL
Zip	:	60018-4914
Country	:	US
Telephone Number	:	847-692-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 E JEFFERSON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2224
Country	:	US
Telephone Number	:	855-214-6583
Fax Number	:	480-606-1012

Authorized Official
Title or Position	:	VP FINANCE
Name	:	CARRIE BILL
Credential	:
Telephone Number	:	847-692-1148

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	01/13/2023

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