Provider Demographics
NPI:1609366533
Name:PODIATRIC PHYSICIANS OF ARIZONA, INC.
Entity Type:Organization
Organization Name:PODIATRIC PHYSICIANS OF ARIZONA, INC.
Other - Org Name:STEWARD MEDICAL GROUP OF ARIZONA / PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-1246
Mailing Address - Street 1:PO BOX 847818
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7818
Mailing Address - Country:US
Mailing Address - Phone:480-834-8804
Mailing Address - Fax:
Practice Address - Street 1:11851 N 51ST AVE STE D120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2839
Practice Address - Country:US
Practice Address - Phone:480-505-0755
Practice Address - Fax:480-505-0750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PODIATRIC PHYSICIANS OF ARIZONA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty