Provider Demographics
NPI:1750350401
Name:ARISTIZABAL, SILVIO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:SILVIO
Middle Name:ANTONIO
Last Name:ARISTIZABAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7760
Practice Address - Street 1:1620 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2624
Practice Address - Country:US
Practice Address - Phone:520-791-7996
Practice Address - Fax:520-791-3329
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80432085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ237554Medicaid
AZ860938204OtherTIN
AZ860938204OtherTIN
AZ237554Medicaid