1265595326 NPI number — ARTHUR SITELMAN MD

Table of content: ARTHUR SITELMAN MD (NPI 1265595326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265595326 NPI number — ARTHUR SITELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SITELMAN
Provider First Name:
ARTHUR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265595326
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9150 W INDIAN SCHOOL RD
Provider Second Line Business Mailing Address:
STE 122
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85037-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-942-6166
Provider Business Mailing Address Fax Number:
602-942-6188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9150 W INDIAN SCHOOL RD STE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037-2387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-889-0100
Provider Business Practice Location Address Fax Number:
623-889-0101
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  16845 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220028181 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 26751901 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0252440 . This is a "BLUE CROSS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".