# ARIZONA INTERVENTIONAL MEDICAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053615021
- **Authorized official:** J THEODORE KING (OWNER)
- **Authorized official phone:** (630) 725-2768

## Contact information

- **Practice address:** 2338 W ROYAL PALM RD, SUITE J, PHOENIX, AZ 85021-9339
- **Practice address phone:** (630) 725-2768
- **Practice address fax:** (877) 219-4810
- **Mailing address:** 1901 BUTTERFIELD RD, 220, DOWNERS GROVE, IL 60515-7915
- **Mailing address phone:** (630) 725-2768
- **Mailing address fax:** (877) 219-4810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | 42646 | AZ | Yes |

## Other

- **Enumeration date:** 01/05/2011
- **Last updated:** 01/05/2011