Provider Demographics
NPI:1619959970
Name:WALL, LIMOR PHILIPP (MD)
Entity Type:Individual
Prefix:
First Name:LIMOR
Middle Name:PHILIPP
Last Name:WALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15571 NORTH REEMS ROAD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-544-6932
Mailing Address - Fax:623-321-1070
Practice Address - Street 1:15571 NORTH REEMS ROAD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-544-6932
Practice Address - Fax:623-321-1070
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ347532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ988743Medicaid
AZ988743Medicaid
AZI03466Medicare UPIN
AZZ120871Medicare PIN