Healthcare Provider Details

I. General information

NPI: 1912199522
Provider Name (Legal Business Name): IM PHYSICIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD SUITE 140
SCOTTSDALE AZ
85251-5648
US

IV. Provider business mailing address

8704 E GAIL RD
SCOTTSDALE AZ
85260-6646
US

V. Phone/Fax

Practice location:
  • Phone: 480-513-2727
  • Fax: 480-513-2729
Mailing address:
  • Phone: 480-443-0062
  • Fax: 480-443-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number31935
License Number StateAZ

VIII. Authorized Official

Name: DR. MOHAMMAD ABOLHASSANI
Title or Position: OWNER
Credential: M.D.
Phone: 480-443-0062