Healthcare Provider Details

I. General information

NPI: 1962428276
Provider Name (Legal Business Name): RAMIN SCHADLU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 N 16TH ST
PHOENIX AZ
85016-5917
US

IV. Provider business mailing address

3840 N 16TH ST
PHOENIX AZ
85016-5917
US

V. Phone/Fax

Practice location:
  • Phone: 602-232-6066
  • Fax: 602-314-4154
Mailing address:
  • Phone: 602-232-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2005008908
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD435175
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number41415
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41415
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: