Provider Demographics
NPI:1902312317
Name:PINNACLE VEIN AND VASCULAR CENTER PLLC
Entity Type:Organization
Organization Name:PINNACLE VEIN AND VASCULAR CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BALJEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-651-3455
Mailing Address - Street 1:9744 W BELL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1343
Mailing Address - Country:US
Mailing Address - Phone:888-553-8346
Mailing Address - Fax:623-404-4530
Practice Address - Street 1:9744 W BELL RD STE A
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1343
Practice Address - Country:US
Practice Address - Phone:885-538-3468
Practice Address - Fax:623-404-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ496162086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty