Healthcare Provider Details

I. General information

NPI: 1467405357
Provider Name (Legal Business Name): MOHAMMAD K DARDARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20266 N LAKE PLEASANT RD STE 105
PEORIA AZ
85382-9711
US

IV. Provider business mailing address

PO BOX 24981
BELFAST ME
04915-2000
US

V. Phone/Fax

Practice location:
  • Phone: 480-716-3002
  • Fax: 602-610-2659
Mailing address:
  • Phone: 602-755-0800
  • Fax: 773-832-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55230
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: