Provider Demographics
NPI:1730330234
Name:ADVANCED KNEE CARE, P.C.
Entity type:Organization
Organization Name:ADVANCED KNEE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-483-0393
Mailing Address - Street 1:8630 E VIA DE VENTURA STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3340
Mailing Address - Country:US
Mailing Address - Phone:480-483-0393
Mailing Address - Fax:480-237-9473
Practice Address - Street 1:8630 E VIA DE VENTURA STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3340
Practice Address - Country:US
Practice Address - Phone:480-483-0393
Practice Address - Fax:480-237-9473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED KNEE CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
AZMD34257261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC75526Medicare UPIN
Z104598Medicare PIN