MEDICARE: BABAK TEHRANCHI DO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	2976	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0712720	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AW4915	OTHER	AZ	HEALTHNET

General Provider Information

NPI Number	:	1083649636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABAK TEHRANCHI DO PC

Provider Business Mailing Address
First Line	:	PO BOX 26904
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85068-6904
Country	:	US
Telephone Number	:	480-596-8525
Fax Number	:	480-596-8522

Provider Business Practice Location Address
First Line	:	6025 S 20TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5428
Country	:	US
Telephone Number	:	480-596-8525
Fax Number	:	480-596-8522

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BABAK TEHRANCHI
Credential	:	D.O.
Telephone Number	:	480-596-8525

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/05/2007

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