Provider Demographics
NPI:1770970022
Name:PHOENIX INSTITUTE OF MICROVASCULAR & PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:PHOENIX INSTITUTE OF MICROVASCULAR & PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COZATT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-331-7811
Mailing Address - Street 1:PO BOX 47548
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7548
Mailing Address - Country:US
Mailing Address - Phone:602-331-7811
Mailing Address - Fax:602-331-5886
Practice Address - Street 1:8900 E RAINTREE DR
Practice Address - Street 2:STE 400
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7307
Practice Address - Country:US
Practice Address - Phone:602-331-7811
Practice Address - Fax:602-331-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty