Provider Demographics
NPI:1275571036
Name:PRIVITERA, LOUIS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ANTHONY
Last Name:PRIVITERA
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 1:7848 W COUNTRY GABLES DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3410
Mailing Address - Country:US
Mailing Address - Phone:623-486-8187
Mailing Address - Fax:623-486-3553
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:SUITE J3
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:623-583-7321
Practice Address - Fax:623-583-7242
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18065208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171124Medicaid
AZ75175Medicare ID - Type Unspecified
AZ171124Medicaid