Healthcare Provider Details

I. General information

NPI: 1619396843
Provider Name (Legal Business Name): TIBA ALWARDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 S PRICE RD
CHANDLER AZ
85248-3544
US

IV. Provider business mailing address

3100 W RAY RD STE 201
CHANDLER AZ
85226-2472
US

V. Phone/Fax

Practice location:
  • Phone: 888-488-7640
  • Fax:
Mailing address:
  • Phone: 480-926-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35132204
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301105179
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: