Provider Demographics
NPI:1275722597
Name:ADVANCED INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-786-9084
Mailing Address - Street 1:1900 W FRYE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6235
Mailing Address - Country:US
Mailing Address - Phone:480-786-9084
Mailing Address - Fax:480-786-9086
Practice Address - Street 1:1900 W FRYE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6235
Practice Address - Country:US
Practice Address - Phone:480-786-9084
Practice Address - Fax:480-786-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ515059Medicaid
AZ515059Medicaid
AZZ118719Medicare PIN