MEDICARE: CARL ROBERT VANSELOW PA

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	363AM0700X	Medical Physician Assistant	2309	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970013946	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1Z5306	OTHER	AZ	HEALTHNET

General Provider Information

NPI Number	:	1730186198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL ROBERT VANSELOW PA

Provider Business Mailing Address
First Line	:	3805 E BELL RD STE 3100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2136
Country	:	US
Telephone Number	:	602-494-3656
Fax Number	:	602-867-3862

Provider Business Practice Location Address
First Line	:	3805 E BELL RD
Second Line	:	SUITE 3100
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2105
Country	:	US
Telephone Number	:	602-867-8644
Fax Number	:	602-795-5698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/29/2022

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Directions to “ CARL ROBERT VANSELOW PA” Practice Location

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