Healthcare Provider Details

I. General information

NPI: 1720991193
Provider Name (Legal Business Name): NIMRI MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 N 20TH AVE
PHOENIX AZ
85015-5101
US

IV. Provider business mailing address

PO BOX 2510
MESA AZ
85214-2510
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-3824
  • Fax:
Mailing address:
  • Phone: 480-821-9339
  • Fax: 480-821-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER NIMRI
Title or Position: PRESIDENT
Credential: MD
Phone: 480-821-9339