Healthcare Provider Details

I. General information

NPI: 1497829659
Provider Name (Legal Business Name): SURA SHARQE ENDOCRINOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 W. SACK DRIVE #204
GLENDALE AZ
85308
US

IV. Provider business mailing address

PO BOX 72327 SURA SHARQE ENDOCRINOLOGY, INC
PHOENIX AZ
85050-1023
US

V. Phone/Fax

Practice location:
  • Phone: 623-825-0237
  • Fax: 623-825-0271
Mailing address:
  • Phone: 623-825-0237
  • Fax: 480-361-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number28217
License Number StateAZ

VIII. Authorized Official

Name: DR. MOMIN MOHAMED GABIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-825-0237