Provider Demographics
NPI:1295119022
Name:ARIZONA WELLNESS MEDICINE LLC
Entity type:Organization
Organization Name:ARIZONA WELLNESS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:216-288-8128
Mailing Address - Street 1:8776 E SHEA BLVD STE 106-196
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:216-288-8128
Mailing Address - Fax:
Practice Address - Street 1:8776 E SHEA BLVD STE 106-196
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6629
Practice Address - Country:US
Practice Address - Phone:216-288-8128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0052132083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty