Provider Demographics
NPI:1851648331
Name:FIDELIS DIAGNOSTICS INC
Entity Type:Organization
Organization Name:FIDELIS DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CTO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-408-2488
Mailing Address - Street 1:7702 E DOUBLETREE RANCH RD
Mailing Address - Street 2:SUITE: 300
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2129
Mailing Address - Country:US
Mailing Address - Phone:877-408-2488
Mailing Address - Fax:866-776-6641
Practice Address - Street 1:7702 E DOUBLETREE RANCH RD
Practice Address - Street 2:SUITE: 300
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2129
Practice Address - Country:US
Practice Address - Phone:877-408-2488
Practice Address - Fax:866-776-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty