Provider Demographics
NPI:1790044410
Name:ADVANCED ORTHOPEDICS, L.L.C.
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-861-7913
Mailing Address - Street 1:4852 E BASELINE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4627
Mailing Address - Country:US
Mailing Address - Phone:480-834-7000
Mailing Address - Fax:480-834-7002
Practice Address - Street 1:4852 E BASELINE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4627
Practice Address - Country:US
Practice Address - Phone:480-834-7000
Practice Address - Fax:480-834-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30294207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty