Provider Demographics
NPI:1104547975
Name:AIM HEALTHCARE PROVIDERS, LLC
Entity type:Organization
Organization Name:AIM HEALTHCARE PROVIDERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-494-2465
Mailing Address - Street 1:161 E RIVULON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0035
Mailing Address - Country:US
Mailing Address - Phone:480-494-2465
Mailing Address - Fax:480-534-4087
Practice Address - Street 1:5025 S ASH AVE STE 6&8
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6839
Practice Address - Country:US
Practice Address - Phone:480-494-2465
Practice Address - Fax:480-534-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty