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General NPI Number Information
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NPI Number | 1053790014
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Entity Type | Organization
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Legal Business Name | ARIZONA UROLOGICAL SURGEONS LLC
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 1728 W GLENDALE AVE SUITE 204
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City | PHOENIX
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State | AZ
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Zip | 85021-8860
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Country | US
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Telephone | 602-445-7112
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Fax | 602-293-3676
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Provider Business Mailing Address
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Address Line | 1728 W GLENDALE AVE SUITE 204
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City | PHOENIX
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State | AZ
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Zip | 85021-8860
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Country | US
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Telephone | 602-445-7112
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Fax | 602-293-3676
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARZBAN MICHAEL HAYYERI
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Credential | M.D.
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Telephone | 602-445-7112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28018
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License Number State | AZ
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