Provider Demographics
NPI:1750513438
Name:ARIZONA HEART SPECIALISTS PLLC
Entity type:Organization
Organization Name:ARIZONA HEART SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-974-3649
Mailing Address - Street 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-974-3649
Mailing Address - Fax:623-974-8364
Practice Address - Street 1:316 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:STE B
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-7015
Practice Address - Country:US
Practice Address - Phone:928-367-9958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ123196Medicare PIN