Provider Demographics
NPI:1134410913
Name:ADVANCED PEDIATRIC CARDIOLOGY, PLLC
Entity type:Organization
Organization Name:ADVANCED PEDIATRIC CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHABIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALHADHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-855-1339
Mailing Address - Street 1:PO BOX 7270
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7270
Mailing Address - Country:US
Mailing Address - Phone:480-855-1339
Mailing Address - Fax:480-857-0313
Practice Address - Street 1:936 W CHANDLER BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2531
Practice Address - Country:US
Practice Address - Phone:480-855-1339
Practice Address - Fax:480-857-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ345972080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty