Organization
ARIZONA KETAMINE SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID VANLIROP MD (MANAGER)
(480) 414-9986
Entity
Organization
Contact information
Practice address
18205 N 51ST AVE STE 105, GLENDALE, AZ 85308-1491
(623) 688-8531
(602) 277-8146
Mailing address
PO BOX 39179, PHOENIX, AZ 85069-9179
(602) 395-0718
(602) 277-8146
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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