Healthcare Provider Details

I. General information

NPI: 1386095743
Provider Name (Legal Business Name): STEVEN MASSAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MESQUITE AVE STE 202
LAKE HAVASU CITY AZ
86403-5681
US

IV. Provider business mailing address

393 LEFFERTS AVE APT 3E
BROOKLYN NY
11225-4331
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-0094
  • Fax: 928-680-8986
Mailing address:
  • Phone: 929-248-9028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59849
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number59849
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: