Provider Demographics
NPI:1316244080
Name:ARIZONA BRAIN AND SPINE CENTER PLLC
Entity type:Organization
Organization Name:ARIZONA BRAIN AND SPINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-663-7346
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5111
Mailing Address - Country:US
Mailing Address - Phone:602-266-2272
Mailing Address - Fax:602-266-2927
Practice Address - Street 1:11000 N SCOTTSDALE RD STE 240
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5111
Practice Address - Country:US
Practice Address - Phone:602-266-2272
Practice Address - Fax:602-266-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ605865Medicaid
AZ605865Medicaid