| Phoenix Id Llc | |
|
340 E Palm Ln Ste 100 Phoenix AZ 85004-4528 | |
| (602) 254-1136 | |
| (602) 272-1720 |
| Full Name | Phoenix Id Llc |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 340 E Palm Ln Ste 100, Phoenix, Arizona |
| Authorized Official Name and Position | Jacob Oommen (OWNER) |
| Authorized Official Contact | 4809077786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Id Llc 3303 S Lindsay Rd Ste 123 Gilbert AZ 85297-2100 Ph: (480) 821-9339 | Phoenix Id Llc 340 E Palm Ln Ste 100 Phoenix AZ 85004-4528 Ph: (602) 254-1136 |
| NPI Number | 1205027646 |
|---|---|
| Provider Enumeration Date | 08/08/2007 |
| Last Update Date | 10/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205027646 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 37316 (Arizona) | Primary |
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