Provider Demographics
NPI:1225408453
Name:ARIZONA ORTHOPAEDIC GROUP PLLC
Entity type:Organization
Organization Name:ARIZONA ORTHOPAEDIC GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-277-1558
Mailing Address - Street 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-277-1558
Mailing Address - Fax:602-266-6691
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-277-1558
Practice Address - Fax:602-266-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11334207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty