Provider Demographics
NPI:1689614489
Name:ARIZONA GASTROENTEROLOGY AND LIVER CLINIC,P.C.
Entity Type:Organization
Organization Name:ARIZONA GASTROENTEROLOGY AND LIVER CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KULBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-993-3600
Mailing Address - Street 1:PO BOX 5130
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5130
Mailing Address - Country:US
Mailing Address - Phone:602-993-3600
Mailing Address - Fax:602-298-1967
Practice Address - Street 1:5130 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4879
Practice Address - Country:US
Practice Address - Phone:602-993-3600
Practice Address - Fax:602-298-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102207Medicare PIN