Basic Information
| Provider Information | |||||||||
| NPI: | 1659914018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL NEUROLOGY OF AZ LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2875 W RAY RD STE 6-343 | ||||||||
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| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852243524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803363816 | ||||||||
| FaxNumber: | 4803369063 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 W BETHANY HOME RD | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850152443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022490212 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2019 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | EL-GENGAIHY | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 4803818398 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
No ID Information.