Healthcare Provider Details

I. General information

NPI: 1417578113
Provider Name (Legal Business Name): MATINE MIRSAIDI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 E RIGGS RD
SUN LAKES AZ
85248-7531
US

IV. Provider business mailing address

20701 N SCOTTSDALE RD # 107-452
SCOTTSDALE AZ
85255-6413
US

V. Phone/Fax

Practice location:
  • Phone: 480-883-2000
  • Fax: 480-919-1949
Mailing address:
  • Phone: 480-424-4738
  • Fax: 480-802-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-001083
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001083
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: