Provider Demographics
NPI:1689915324
Name:CLASSIC CARE PEDIATRICS LLC
Entity Type:Organization
Organization Name:CLASSIC CARE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPHE
Authorized Official - Last Name:GETTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-262-4926
Mailing Address - Street 1:7757 W DEER VALLEY RD
Mailing Address - Street 2:SUITE275
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2118
Mailing Address - Country:US
Mailing Address - Phone:623-262-4926
Mailing Address - Fax:
Practice Address - Street 1:7757 W DEER VALLEY RD
Practice Address - Street 2:SUITE275
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2118
Practice Address - Country:US
Practice Address - Phone:623-262-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23947208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty