Provider Demographics
NPI:1114972395
Name:PARISE, MARIO T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:T
Last Name:PARISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:# 113
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-583-6420
Mailing Address - Fax:623-583-6421
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:# 113
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-583-6420
Practice Address - Fax:623-583-6421
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19729207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ297087Medicaid
AZ79185Medicare ID - Type Unspecified
AZ297087Medicaid
AZP00002007Medicare PIN
AZZ71534Medicare PIN