Healthcare Provider Details

I. General information

NPI: 1740120278
Provider Name (Legal Business Name): AHMED DUDIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

16825 N 14TH ST UNIT 93
PHOENIX AZ
85022-7740
US

V. Phone/Fax

Practice location:
  • Phone: 602-655-6300
  • Fax:
Mailing address:
  • Phone: 801-815-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: