| |
13657 W Mcdowell Rd Suite 118 Goodyear AZ 85395-2601 | |
(623) 328-7794 | |
(623) 328-7932 |
Full Name | |
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Speciality | Internal Medicine - Infectious Disease |
Location | 13657 W Mcdowell Rd, Goodyear, Arizona |
Authorized Official Name and Position | Tara Kowalski (CREDENTIALING MANAGER) |
Authorized Official Contact | 8882206432 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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901 Mcclintock Dr Suite 202 Burr Ridge IL 60527-0871 Ph: (888) 220-6432 | 13657 W Mcdowell Rd Suite 118 Goodyear AZ 85395-2601 Ph: (623) 328-7794 |
NPI Number | 1073854600 |
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Provider Enumeration Date | 03/06/2013 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073854600 | NPI | - | NPPES |
780223 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | (Arizona) | Primary |
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