Healthcare Provider Details

I. General information

NPI: 1558597302
Provider Name (Legal Business Name): ALSHAM ENDOCRINOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 W HARRISON ST
CHANDLER AZ
85226-2379
US

IV. Provider business mailing address

PO BOX 6746
CHANDLER AZ
85246-6746
US

V. Phone/Fax

Practice location:
  • Phone: 480-275-4938
  • Fax: 480-275-6626
Mailing address:
  • Phone: 480-275-4938
  • Fax: 480-275-6626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number32215
License Number StateAZ

VIII. Authorized Official

Name: MOHAMAD H HORANI
Title or Position: PROPRIETOR
Credential: MD
Phone: 480-275-4938