Healthcare Provider Details

I. General information

NPI: 1235186628
Provider Name (Legal Business Name): JUNAID I. QURESHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 W GLENDALE AVE STE 204
PHOENIX AZ
85021-8863
US

IV. Provider business mailing address

4531 N 16TH ST STE 114
PHOENIX AZ
85016-5344
US

V. Phone/Fax

Practice location:
  • Phone: 623-522-4935
  • Fax: 623-522-4937
Mailing address:
  • Phone: 480-839-3313
  • Fax: 602-296-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number33986
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33986
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33986
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: