Healthcare Provider Details

I. General information

NPI: 1366132318
Provider Name (Legal Business Name): ABDULLAH MOHAMED NIYAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date: 12/18/2023
Reactivation Date: 02/12/2024

III. Provider practice location address

400 N 32ND STREET BUMCP INTERNAL MEDICINE CLINIC
PHOENIX AZ
85008
US

IV. Provider business mailing address

400 N 32ND STREET BUMCP INTERNAL MEDICINE CLINIC
PHOENIX AZ
85008
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-3927
  • Fax:
Mailing address:
  • Phone: 602-839-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: