Healthcare Provider Details

I. General information

NPI: 1124201777
Provider Name (Legal Business Name): COLORECTAL CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 E IRONWOOD SQUARE DR STE 102
SCOTTSDALE AZ
85258-4576
US

IV. Provider business mailing address

PO BOX 4023
SCOTTSDALE AZ
85261-4023
US

V. Phone/Fax

Practice location:
  • Phone: 480-240-7391
  • Fax: 480-240-7391
Mailing address:
  • Phone: 480-240-7391
  • Fax: 480-240-7391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number34222
License Number StateAZ

VIII. Authorized Official

Name: DR. RAED TARAZI
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 480-240-7391