Provider Demographics
NPI:1003005893
Name:ENDOCRINOLOGY, DIABETES, AND THYROID CENTER OF ARIZONA PLLC
Entity Type:Organization
Organization Name:ENDOCRINOLOGY, DIABETES, AND THYROID CENTER OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JASJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-885-7003
Mailing Address - Street 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE F-635
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:623-266-7858
Mailing Address - Fax:623-444-9810
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE F-635
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:623-266-7858
Practice Address - Fax:623-444-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36320207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH86303Medicare UPIN