Healthcare Provider Details

I. General information

NPI: 1891740296
Provider Name (Legal Business Name): EFFIDEEN AMEERALLY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7436 E MAIN ST STE 2
MESA AZ
85207-8338
US

IV. Provider business mailing address

7436 E MAIN ST STE 2
MESA AZ
85207-9338
US

V. Phone/Fax

Practice location:
  • Phone: 480-325-9600
  • Fax: 480-907-2355
Mailing address:
  • Phone: 480-325-9600
  • Fax: 480-712-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17561
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number17561
License Number StateAZ

VIII. Authorized Official

Name: DR. AMIT PATEL
Title or Position: OWNER
Credential: MD
Phone: 405-921-2503