Healthcare Provider Details

I. General information

NPI: 1225692676
Provider Name (Legal Business Name): PEDRAM MOTAMEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 204
PHOENIX AZ
85032-3356
US

IV. Provider business mailing address

4727 E BELL RD STE 45-287
PHOENIX AZ
85032-2308
US

V. Phone/Fax

Practice location:
  • Phone: 480-791-2422
  • Fax: 602-953-5466
Mailing address:
  • Phone: 480-791-2422
  • Fax: 602-953-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number74354
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: