=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871318055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD HEALTH MEDICAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2024
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11749 W LONE MOUNTAIN PKWY UNIT 105
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85383-6801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-677-8282
-----------------------------------------------------
Fax | 844-470-2777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 261 N ROOSEVELT AVE
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85226-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-677-8282
-----------------------------------------------------
Fax | 844-470-2777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PAYAM ZAMANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-305-2888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------