Provider Demographics
NPI:1306974217
Name:TATUM INTERNAL MEDICINE & ASSOCIATES PLLC
Entity type:Organization
Organization Name:TATUM INTERNAL MEDICINE & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARIATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-482-5444
Mailing Address - Street 1:4729 E UNION HILLS DR
Mailing Address - Street 2:# 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3390
Mailing Address - Country:US
Mailing Address - Phone:602-482-5444
Mailing Address - Fax:602-482-5666
Practice Address - Street 1:4729 E UNION HILLS DR
Practice Address - Street 2:STE #111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3390
Practice Address - Country:US
Practice Address - Phone:602-482-5444
Practice Address - Fax:602-482-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20889173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1306974217OtherGROUP NPI
AZZ60590Medicare PIN