Provider Demographics
NPI:1497293898
Name:SURPRISE MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:SURPRISE MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRITPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-670-8749
Mailing Address - Street 1:41809 N LA CANTERA DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1946
Mailing Address - Country:US
Mailing Address - Phone:623-670-8749
Mailing Address - Fax:623-544-6861
Practice Address - Street 1:14674 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2706
Practice Address - Country:US
Practice Address - Phone:623-544-6860
Practice Address - Fax:623-544-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty