Healthcare Provider Details

I. General information

NPI: 1861757494
Provider Name (Legal Business Name): MISAM ZAWIT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

IV. Provider business mailing address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

V. Phone/Fax

Practice location:
  • Phone: 844-675-9338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35.126105
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125060840
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number73271
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.126105
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number73271
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: