Provider Demographics
NPI:1265809628
Name:SCOTTSDALE HEART & VASCULAR ASSOCIATES LLC
Entity type:Organization
Organization Name:SCOTTSDALE HEART & VASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-269-7641
Mailing Address - Street 1:PO BOX 6193
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-6193
Mailing Address - Country:US
Mailing Address - Phone:480-269-7641
Mailing Address - Fax:
Practice Address - Street 1:4040 E LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7420
Practice Address - Country:US
Practice Address - Phone:480-269-7641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27334207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty