Healthcare Provider Details

I. General information

NPI: 1417910167
Provider Name (Legal Business Name): AMAD ZINELDINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 E FLORENTINE RD STE 206
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-442-8117
  • Fax: 928-772-8947
Mailing address:
  • Phone: 928-759-5987
  • Fax: 928-458-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5041
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number56901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: