Provider Demographics
NPI:1285841817
Name:FAMILY PRACTICE MEDICINE PLLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THIRU
Authorized Official - Middle Name:
Authorized Official - Last Name:SKANTHAROOPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-661-5550
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:SUITE# 207
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE# 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-661-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102864Medicare PIN