Provider Demographics
NPI:1164138079
Name:CREOSOTE TOTAL HEALTH
Entity Type:Organization
Organization Name:CREOSOTE TOTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARIOT SHEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-737-5293
Mailing Address - Street 1:8380 S KYRENE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2120
Mailing Address - Country:US
Mailing Address - Phone:480-253-9022
Mailing Address - Fax:
Practice Address - Street 1:8380 S KYRENE RD STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2120
Practice Address - Country:US
Practice Address - Phone:480-965-6341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty