Provider Demographics
NPI:1689126971
Name:AZMOBILEMD
Entity Type:Organization
Organization Name:AZMOBILEMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-218-4171
Mailing Address - Street 1:39506 N DAISY MOUNTAIN DR STE 122-627
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6084
Mailing Address - Country:US
Mailing Address - Phone:623-218-4171
Mailing Address - Fax:623-321-1917
Practice Address - Street 1:39506 N DAISY MOUNTAIN DR STE 122-627
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-6084
Practice Address - Country:US
Practice Address - Phone:623-218-4171
Practice Address - Fax:623-321-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42672207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty