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NPI Code Detail

MEDICARE: 28TH STREET MEDICAL GROUP, LLC

MEDICARE: 28TH STREET MEDICAL GROUP, LLC
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
1111N00000XChiropractor
2208100000XPhysical Medicine & Rehabilitation Physician
3225100000XPhysical Therapist
4363A00000XPhysician Assistant
5208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1447723598
Entity Type Code : Organization
Provider Name (Legal Business Name) : 28TH STREET MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : PO BOX 6610
Second Line :
City : CHANDLER
State : AZ
Zip : 85246-6610
Country : US
Telephone Number : 480-926-7800
Fax Number : 480-926-2260
Provider Business Practice Location Address
First Line : 2836 E INDIAN SCHOOL RD STE A8
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-6864
Country : US
Telephone Number : 602-840-0056
Fax Number : 480-926-2260
Authorized Official
Title or Position : OWNER
Name : RADMAN RAHIMINEJAD
Credential :
Telephone Number : 480-926-7800
Provider Enumeration Date : 01/10/2019
Last Update Date : 01/05/2023

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Directions to “28TH STREET MEDICAL GROUP, LLC ” Practice Location

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