Healthcare Provider Details

I. General information

NPI: 1588212443
Provider Name (Legal Business Name): STEM MED ROTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9295 E THUNDERBIRD RD
SCOTTSDALE AZ
85260-4376
US

IV. Provider business mailing address

9215 N INVERGORDON RD
PARADISE VALLEY AZ
85253-1806
US

V. Phone/Fax

Practice location:
  • Phone: 716-410-0402
  • Fax:
Mailing address:
  • Phone: 716-410-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EMAD ZAKI
Title or Position: OWNER
Credential: MD
Phone: 716-410-0402