Provider Demographics
NPI:1568673499
Name:CONSULTANTS IN INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:CONSULTANTS IN INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-843-1313
Mailing Address - Street 1:5701 W TALAVI BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1887
Mailing Address - Country:US
Mailing Address - Phone:602-843-1313
Mailing Address - Fax:602-843-0191
Practice Address - Street 1:5651 W TALAVI BLVD STE 170
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1893
Practice Address - Country:US
Practice Address - Phone:602-843-1313
Practice Address - Fax:602-843-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19199261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ24095Medicare ID - Type Unspecified
AZE47408Medicare UPIN