1720512171 NPI number — MIR-MUHAMMAD RAZAVI MD

Table of content: MIR-MUHAMMAD RAZAVI MD (NPI 1720512171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720512171 NPI number — MIR-MUHAMMAD RAZAVI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAZAVI
Provider First Name:
MIR-MUHAMMAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1720512171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOMC ATTN HOSPITALISTS
Provider Second Line Business Mailing Address:
1405 S ALMA SCHOOL RD
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-256-7420
Provider Business Mailing Address Fax Number:
480-646-3826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BOMC ATTN HOSPITALISTS
Provider Second Line Business Practice Location Address:
1405 S ALMA SCHOOL RD
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-256-7420
Provider Business Practice Location Address Fax Number:
480-646-3826
Provider Enumeration Date:
04/12/2017

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: 207R00000X , with the licence number:  61625 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 61625 , 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)