Provider Demographics
NPI:1922382712
Name:PULMONARY CLINICS OF SCOTTSDALE, PLLC
Entity Type:Organization
Organization Name:PULMONARY CLINICS OF SCOTTSDALE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-970-9649
Mailing Address - Street 1:15029 N THOMPSON PEAK PKWY
Mailing Address - Street 2:SUITE B111-525
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2217
Mailing Address - Country:US
Mailing Address - Phone:480-970-9649
Mailing Address - Fax:480-970-9532
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4510
Practice Address - Country:US
Practice Address - Phone:480-970-9649
Practice Address - Fax:480-970-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32659207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ888638Medicaid