Healthcare Provider Details

I. General information

NPI: 1609877935
Provider Name (Legal Business Name): NADIM T ZYADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 W BETHANY HOME RD SUITE 2
PHOENIX AZ
85015-1934
US

IV. Provider business mailing address

PO BOX 27340
PHOENIX AZ
85061-7340
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-6666
  • Fax: 602-242-9220
Mailing address:
  • Phone: 602-943-9200
  • Fax: 602-216-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: