Healthcare Provider Details

I. General information

NPI: 1366970931
Provider Name (Legal Business Name): MOHAMAD HEMU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13634 N 93RD AVE STE 300
PEORIA AZ
85381-4915
US

IV. Provider business mailing address

13634 N 93RD AVE STE 300
PEORIA AZ
85381-4915
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2484
  • Fax: 623-815-2483
Mailing address:
  • Phone: 623-815-2484
  • Fax: 623-815-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number76337
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number76337
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: