Organization
TAKAYAMA 90 MED PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE GROSS (VP OF REVENUE CYCLE)
(214) 615-5168
Entity
Organization
Contact information
Practice address
14848 N 15TH DR, PHOENIX, AZ 85023-5181
(214) 615-5168
(888) 526-9542
Mailing address
PO BOX 3837, CAROL STREAM, IL 60132-3837
(214) 615-5168
(888) 526-9542
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
41788
AZ
Other
Enumeration date
01/27/2014
Last updated
01/27/2014
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