Provider Demographics
NPI:1083921738
Name:PHOENIX ORTHOPEDIC INSTITUTE PLLC
Entity Type:Organization
Organization Name:PHOENIX ORTHOPEDIC INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAJAPOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-820-0999
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:3006 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3851
Practice Address - Country:US
Practice Address - Phone:480-820-0999
Practice Address - Fax:480-557-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty