Provider Demographics
NPI:1013167642
Name:ARIZONA ADVANCED INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:ARIZONA ADVANCED INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-867-0111
Mailing Address - Street 1:18404 N TATUM BLVD
Mailing Address - Street 2:206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1510
Mailing Address - Country:US
Mailing Address - Phone:602-867-0111
Mailing Address - Fax:
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-867-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE95666Medicare UPIN