1881810224 NPI number — DR. ALI AZADI M.D.

Table of content: DR. ALI AZADI M.D. (NPI 1881810224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881810224 NPI number — DR. ALI AZADI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZADI
Provider First Name:
ALI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881810224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3983 E SCOUT PASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85050-5463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-271-8666
Provider Business Mailing Address Fax Number:
623-271-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14155 N 83RD AVE STE 138
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-5652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-271-8666
Provider Business Practice Location Address Fax Number:
623-271-9229
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  38152 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 36152 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VF0040X , with the licence number: 38152 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158647 . This is a "SIHO-WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50024904 . This is a "PASSPORT PCP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000610828 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200943770 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000859185 . This is a "ANTHEM-WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3726876000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50024900 . This is a "PASSPORT SPECIALITY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3726874000 . This is a "PASSPORT ADVANTAGE PCP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9393153 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3726870000 . This is a "PASSPORT ADVANTAGE SPECIALITY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50024906 . This is a "PASSPORT SPECIALITY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000610873 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0722553 . This is a "MEDICARE - FOUNDATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 335673 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50069587 . This is a "PASSPORT-WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100074140 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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