Provider Demographics
NPI:1093380941
Name:VASCULAR INSTITUTE OF ARIZONA PLLC
Entity type:Organization
Organization Name:VASCULAR INSTITUTE OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-936-7722
Mailing Address - Street 1:2040 S ALMA SCHOOL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7076
Mailing Address - Country:US
Mailing Address - Phone:480-936-7722
Mailing Address - Fax:480-936-7723
Practice Address - Street 1:21321 E OCOTILLO RD STE 125
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5995
Practice Address - Country:US
Practice Address - Phone:480-936-7722
Practice Address - Fax:480-936-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty