Provider Demographics
NPI:1437681129
Name:MAIAN PEDIATRICS,PLLC
Entity Type:Organization
Organization Name:MAIAN PEDIATRICS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ERSKINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-804-0320
Mailing Address - Street 1:30012 N CAVE CREEK RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5833
Mailing Address - Country:US
Mailing Address - Phone:480-912-6214
Mailing Address - Fax:
Practice Address - Street 1:30012 N CAVE CREEK RD
Practice Address - Street 2:SUITE #101
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5833
Practice Address - Country:US
Practice Address - Phone:480-528-6502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126923Medicaid
AZ111166Medicare Oscar/Certification
AZ126923Medicaid
AZZ141309Medicare PIN