| Envi Pllc | |
|
15396 N 83rd Ave Ste E Peoria AZ 85381-5627 | |
| (623) 300-3684 | |
| (602) 671-3684 |
| Full Name | Envi Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15396 N 83rd Ave Ste E, Peoria, Arizona |
| Authorized Official Name and Position | Asad Ehtisham (OWNER) |
| Authorized Official Contact | 6233003684 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envi Pllc 15396 N 83rd Ave Ste E Peoria AZ 85381-5627 Ph: () - | Envi Pllc 15396 N 83rd Ave Ste E Peoria AZ 85381-5627 Ph: (623) 300-3684 |
| NPI Number | 1396145264 |
|---|---|
| Provider Enumeration Date | 08/28/2014 |
| Last Update Date | 10/20/2020 |
| Certification Date | 10/20/2020 |
| Medicare PECOS PAC ID | 4082939392 |
|---|---|
| Medicare Enrollment ID | O20150209001005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396145264 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
| Provider Name | Asad Ehtisham |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558366856 PECOS PAC ID: 2365412509 Enrollment ID: I20130904000965 |
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