Provider Demographics
NPI:1902252661
Name:MINIMALLY INVASIVE THERAPEUTICS PLLC
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE THERAPEUTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-759-0290
Mailing Address - Street 1:22219 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7397
Mailing Address - Country:US
Mailing Address - Phone:602-759-0290
Mailing Address - Fax:602-428-7007
Practice Address - Street 1:26362 N 168TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-6812
Practice Address - Country:US
Practice Address - Phone:602-759-0290
Practice Address - Fax:602-428-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41013174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ823651Medicaid
AZ1821251083OtherNPI