Healthcare Provider Details

I. General information

NPI: 1336883065
Provider Name (Legal Business Name): ELIRAN ELI ZADIKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 N 7TH AVE
PHOENIX AZ
85013-4102
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3153
  • Fax:
Mailing address:
  • Phone: 602-406-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: