Provider Demographics
NPI:1649546193
Name:OVIL, ACE ASSAF (MD)
Entity type:Individual
Prefix:DR
First Name:ACE
Middle Name:ASSAF
Last Name:OVIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ASSA
Other - Middle Name:
Other - Last Name:OVIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16601 N 40TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3356
Mailing Address - Country:US
Mailing Address - Phone:602-633-3721
Mailing Address - Fax:602-595-1127
Practice Address - Street 1:16601 N 40TH ST STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3356
Practice Address - Country:US
Practice Address - Phone:602-633-3721
Practice Address - Fax:602-595-1127
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301111897390200000X
AZ561272086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ424425Medicaid