Basic Information
| Provider Information | |||||||||
| NPI: | 1063642304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA ORTHOPAEDIC FOOT & ANKLE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26205 | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852550120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804733668 | ||||||||
| FaxNumber: | 4804733671 | ||||||||
| Practice Location | |||||||||
| Address1: | 20201 N SCOTTSDALE HEALTHCARE DR | ||||||||
| Address2: | STE 280 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852554134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804733668 | ||||||||
| FaxNumber: | 4804733671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 07/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | CASTRO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4804733668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 005096 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 342593 | 05 | AZ | MEDICAID |