Individual
INA SOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MSC
Contact information
Practice address
13400 E SHEA BLVD, SCOTTSDALE, AZ 85259
(480) 301-8000
Mailing address
13400 E SHEA BLVD, SCOTTSDALE, AZ 85259-5452
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
LP02818
RI
2086S0129X
Vascular Surgery Physician
Primary
56661
AZ
2086S0129X
Vascular Surgery Physician
PENDING
AZ
Other
Enumeration date
05/30/2013
Last updated
09/03/2020
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