Healthcare Provider Details

I. General information

NPI: 1871116905
Provider Name (Legal Business Name): MARWAN AL-ANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 W HAPPY VALLEY PKWY STE 100
PEORIA AZ
85383-4692
US

IV. Provider business mailing address

10230 W HAPPY VALLEY PKWY STE 100
PEORIA AZ
85383-4692
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-3030
  • Fax:
Mailing address:
  • Phone: 623-561-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70448
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: