Provider Demographics
NPI:1780779629
Name:A GIANNI VISHTEH MD PC
Entity type:Organization
Organization Name:A GIANNI VISHTEH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:GIANNI
Authorized Official - Last Name:VISHTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-827-2200
Mailing Address - Street 1:PO BOX 44752
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4752
Mailing Address - Country:US
Mailing Address - Phone:480-827-2200
Mailing Address - Fax:480-827-0318
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:480-827-2200
Practice Address - Fax:480-827-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68202Medicare PIN