Provider Demographics
NPI:1265759484
Name:VASCULAR SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:VASCULAR SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOBRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-839-2682
Mailing Address - Street 1:2072 E. LA VIEVE LANE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3515
Mailing Address - Country:US
Mailing Address - Phone:480-839-2682
Mailing Address - Fax:480-839-2682
Practice Address - Street 1:2055 EAST SOUTHERN AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:480-440-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ94362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z136922Medicare Oscar/Certification
C99168Medicare UPIN