Provider Demographics
NPI:1336829894
Name:PREMIERE GI PLLC
Entity Type:Organization
Organization Name:PREMIERE GI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAZANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-334-9040
Mailing Address - Street 1:11505 PALMBRUSH TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2904
Mailing Address - Country:US
Mailing Address - Phone:941-334-9040
Mailing Address - Fax:941-334-9030
Practice Address - Street 1:11505 PALMBRUSH TRL STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2904
Practice Address - Country:US
Practice Address - Phone:941-334-9040
Practice Address - Fax:941-334-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty