MEDICARE: DR. MONALIZA SETUDEHNIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25255	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043287170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONALIZA SETUDEHNIA MD

Provider Business Mailing Address
First Line	:	2055 E SOUTHERN AVE
Second Line	:	SUITE D
City	:	TEMPE
State	:	AZ
Zip	:	85282-7507
Country	:	US
Telephone Number	:	480-345-7676
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 E SOUTHERN AVE
Second Line	:	SUITE D
City	:	TEMPE
State	:	AZ
Zip	:	85282-7507
Country	:	US
Telephone Number	:	480-345-7676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/13/2016

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