Provider Demographics
NPI:1487105557
Name:ABUNDANT HEALTH MEDICAL PLLC
Entity type:Organization
Organization Name:ABUNDANT HEALTH MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-802-0797
Mailing Address - Street 1:4913 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5630
Mailing Address - Country:US
Mailing Address - Phone:480-802-0797
Mailing Address - Fax:480-895-5968
Practice Address - Street 1:4913 S ALMA SCHOOL RD
Practice Address - Street 2:STE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5630
Practice Address - Country:US
Practice Address - Phone:480-802-0797
Practice Address - Fax:480-895-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83120Medicare PIN