Provider Demographics
NPI:1285642660
Name:BACH, TINA (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2733 N POWER RD
Mailing Address - Street 2:SUITE 102-417
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1682
Mailing Address - Country:US
Mailing Address - Phone:602-954-0444
Mailing Address - Fax:602-952-7146
Practice Address - Street 1:8111 E THOMAS RD
Practice Address - Street 2:SUITE 124
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5844
Practice Address - Country:US
Practice Address - Phone:602-954-0444
Practice Address - Fax:602-952-7146
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ24368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ361519OtherAHCCCS
AZ361519OtherAHCCCS
AZG36316Medicare UPIN
AZZ128093Medicare PIN