MEDICARE: PHOENIX NEUROLOGICAL INSTITUTE INC

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	2084P0800X	Psychiatry Physician
2	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1770364564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX NEUROLOGICAL INSTITUTE INC

Provider Business Mailing Address
First Line	:	1343 N ALMA SCHOOL RD STE 160
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5901
Country	:	US
Telephone Number	:	480-444-7472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2226 W NORTHERN AVE STE C212
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4929
Country	:	US
Telephone Number	:	480-444-7472
Fax Number	:	480-912-7910

Authorized Official
Title or Position	:	COO
Name	:	ANUPAM AHLAWAT
Credential	:
Telephone Number	:	480-444-7447

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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