Provider Demographics
NPI:1467414219
Name:ARIZONA DIGESTIVE & LIVER DISEASE CONSULTANTS
Entity Type:Organization
Organization Name:ARIZONA DIGESTIVE & LIVER DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-843-1265
Mailing Address - Street 1:5823 W EUGIE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1276
Mailing Address - Country:US
Mailing Address - Phone:602-843-1265
Mailing Address - Fax:602-843-1297
Practice Address - Street 1:5823 W EUGIE AVE
Practice Address - Street 2:STE A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1276
Practice Address - Country:US
Practice Address - Phone:602-843-1265
Practice Address - Fax:602-843-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WCGWLMedicare ID - Type Unspecified