Organization · NPI-2

Aegis Iom, PLLC

· Phoenix, AZ

NPI number1194217596
StatusActive
Last updated in NPPESMay 31, 2018

Details

NPI
1194217596
Entity type
Organization (NPI-2)
Legal business name
Aegis Iom, PLLC
Organization subpart
No
Enumeration date
May 31, 2018
Last updated
May 31, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084N0600X ––Yes

Practice location

5323 E Palomino Rd
Phoenix, AZ 85018-1911

Phone 702-670-1588

Mailing address

Po Box 41861
Mesa, AZ 85274-1861

Authorized official

Elise Kilmer
Manager
7026701588

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