Healthcare Provider Details

I. General information

NPI: 1972882637
Provider Name (Legal Business Name): HASAN ALDAILAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7351 E OSBORN RD STE 100
SCOTTSDALE AZ
85251-6451
US

IV. Provider business mailing address

7351 E OSBORN RD STE 100
SCOTTSDALE AZ
85251-6451
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7465
  • Fax:
Mailing address:
  • Phone: 917-833-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number67853
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: