Provider Demographics
NPI:1851955421
Name:PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY LLC
Entity Type:Organization
Organization Name:PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY LLC
Other - Org Name:SCOTTSDALE UROGYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AKL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-399-3699
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:480-656-0207
Mailing Address - Fax:480-939-3506
Practice Address - Street 1:10661 N FRANK LLOYD WRIGHT BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2687
Practice Address - Country:US
Practice Address - Phone:480-656-0207
Practice Address - Fax:480-939-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty