Basic Information
Provider Information | |||||||||
NPI: | 1215124201 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AKDHC, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3003 N CENTRAL AVE | ||||||||
Address2: | STE 400 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850122902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6029970484 | ||||||||
FaxNumber: | 6029446882 | ||||||||
Practice Location | |||||||||
Address1: | 10750 W MCDOWELL RD | ||||||||
Address2: | STE F 600 | ||||||||
City: | AVONDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 853925971 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6235474668 | ||||||||
FaxNumber: | 6235357869 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2007 | ||||||||
LastUpdateDate: | 05/22/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LUZ | ||||||||
AuthorizedOfficialFirstName: | SUSAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 6023513015 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CPCS | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.