Provider Demographics
NPI:1073795571
Name:ACCREDITED CENTER FOR DIGESTIVE HEALTH PLLC
Entity Type:Organization
Organization Name:ACCREDITED CENTER FOR DIGESTIVE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-733-0500
Mailing Address - Street 1:2563 S VAL VISTA DR
Mailing Address - Street 2:STE 101A
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:480-733-0500
Mailing Address - Fax:480-396-9974
Practice Address - Street 1:2563 S VAL VISTA DR
Practice Address - Street 2:STE 101A
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-985-9005
Practice Address - Fax:480-396-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77678OtherPHYSICIAN UPIN