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General NPI Number Information
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NPI Number | 1700244613
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Entity Type | Organization
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Legal Business Name | MAK ANESTHESIA PLLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 6245 N 16TH ST
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City | PHOENIX
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State | AZ
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Zip | 85016-1706
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Country | US
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Telephone | 602-309-4709
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Fax | 602-419-2951
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Provider Business Mailing Address
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Address Line | PO BOX 29211
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City | PHOENIX
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State | AZ
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Zip | 85038-9211
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Country | US
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Telephone | 602-273-6670
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Fax | 602-267-8919
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMAN FARNOUSH
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Credential | M.D.
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Telephone | 602-309-4709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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