Healthcare Provider Details

I. General information

NPI: 1568660660
Provider Name (Legal Business Name): MOHAMMAD REZA KARAMI-SICHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 EAST BECKER LANE
SCOTTSDALE AZ
85269
US

IV. Provider business mailing address

10770 EAST BECKER LANE
SCOTTSDALE AZ
85259
US

V. Phone/Fax

Practice location:
  • Phone: 480-659-0888
  • Fax: 480-659-0714
Mailing address:
  • Phone: 731-499-0888
  • Fax: 480-659-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number31022
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28437
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: