Provider Demographics
NPI:1144231895
Name:ARIZONA STATE UROLOGICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:ARIZONA STATE UROLOGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANOOP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-985-1093
Mailing Address - Street 1:2730 S VAL VISTA DR BUILDING 13
Mailing Address - Street 2:STE 177
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1683
Mailing Address - Country:US
Mailing Address - Phone:480-394-0200
Mailing Address - Fax:480-394-0202
Practice Address - Street 1:2730 S VAL VISTA DR BUILDING 13
Practice Address - Street 2:STE 177
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1683
Practice Address - Country:US
Practice Address - Phone:480-394-0200
Practice Address - Fax:480-394-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75619Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER