Provider Demographics
NPI:1922621739
Name:TITAN MEDICAL LLC
Entity Type:Organization
Organization Name:TITAN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHADEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-299-9988
Mailing Address - Street 1:20340 N LAKE PLEASANT RD STE 109
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9713
Mailing Address - Country:US
Mailing Address - Phone:623-299-9988
Mailing Address - Fax:
Practice Address - Street 1:13660 N 94TH DR STE D-3
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-230-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty