Provider Demographics
NPI:1285901819
Name:ANITA DAI MD INTEGRATIVE CARE LLC
Entity type:Organization
Organization Name:ANITA DAI MD INTEGRATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:LATSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-888-5421
Mailing Address - Street 1:1909 E RAY RD
Mailing Address - Street 2:STE 9-154
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8724
Mailing Address - Country:US
Mailing Address - Phone:480-888-5421
Mailing Address - Fax:855-847-8908
Practice Address - Street 1:10404 W COGGINS DR
Practice Address - Street 2:STE 118
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3465
Practice Address - Country:US
Practice Address - Phone:623-972-1055
Practice Address - Fax:623-972-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ37198OtherMEDICAL LICENSE
AZ228405Medicaid
AZ120622Medicare UPIN