Provider Demographics
NPI:1275864563
Name:HEART RHYTHM SPECIALIST OF AZ
Entity Type:Organization
Organization Name:HEART RHYTHM SPECIALIST OF AZ
Other - Org Name:HEART RYHTHM SPECIALIST OF AZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-481-9318
Mailing Address - Street 1:20950 N TATUM BLVD
Mailing Address - Street 2:270
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4200
Mailing Address - Country:US
Mailing Address - Phone:602-481-9318
Mailing Address - Fax:602-759-1966
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:270
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:602-481-9318
Practice Address - Fax:602-759-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34004207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBS6092124OtherDEA
AZG82762Medicare UPIN
AZBS6092124OtherDEA