Healthcare Provider Details

I. General information

NPI: 1114545506
Provider Name (Legal Business Name): MIRAGE PODIATRY FOOT AND ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 3020
PHOENIX AZ
85020-2425
US

IV. Provider business mailing address

9250 N 3RD ST STE 3020
PHOENIX AZ
85020-2425
US

V. Phone/Fax

Practice location:
  • Phone: 480-939-3440
  • Fax: 480-939-3448
Mailing address:
  • Phone: 480-939-3440
  • Fax: 480-939-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. HAMMAD MOHAMMAD ZAFAR
Title or Position: DOCTOR
Credential: DPM
Phone: 480-358-7970