Healthcare Provider Details

I. General information

NPI: 1154615607
Provider Name (Legal Business Name): AMIR AZADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE # 470
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

240 W THOMAS RD # 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-6387
  • Fax: 602-406-2931
Mailing address:
  • Phone: 602-406-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number56511
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: