Provider Demographics
NPI:1730305335
Name:SCOTTSDALE UROLOGIC SURGEONS, LTD
Entity Type:Organization
Organization Name:SCOTTSDALE UROLOGIC SURGEONS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-949-1212
Mailing Address - Street 1:7301 E 2ND ST
Mailing Address - Street 2:STE 308
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5600
Mailing Address - Country:US
Mailing Address - Phone:480-949-1212
Mailing Address - Fax:480-994-5633
Practice Address - Street 1:7301 E 2ND ST
Practice Address - Street 2:STE 308
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:480-949-1212
Practice Address - Fax:480-994-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWMBKRMedicare PIN