MEDICARE: ADVANCED ORTHOPEDICS, L.L.C.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	30294	AZ

General Provider Information

NPI Number	:	1790044410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ORTHOPEDICS, L.L.C.

Provider Business Mailing Address
First Line	:	4852 E BASELINE RD
Second Line	:	SUITE 107
City	:	MESA
State	:	AZ
Zip	:	85206-4627
Country	:	US
Telephone Number	:	480-834-7000
Fax Number	:	480-834-7002

Provider Business Practice Location Address
First Line	:	4852 E BASELINE RD
Second Line	:	SUITE 107
City	:	MESA
State	:	AZ
Zip	:	85206-4627
Country	:	US
Telephone Number	:	480-834-7000
Fax Number	:	480-834-7002

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DANIEL JOSEPH MULLEN
Credential	:	M.D.
Telephone Number	:	480-861-7913

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	09/21/2012

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