MEDICARE: DR. SEYED MOHSEN SHARIFI TAKIEH M.D.

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	207RC0000X	Cardiovascular Disease Physician	33949	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144294109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEYED MOHSEN SHARIFI TAKIEH M.D.

Provider Business Mailing Address
First Line	:	3850 E BASELINE RD STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4403
Country	:	US
Telephone Number	:	480-924-0006
Fax Number	:	480-924-0659

Provider Business Practice Location Address
First Line	:	3850 E BASELINE RD STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4403
Country	:	US
Telephone Number	:	480-924-0006
Fax Number	:	480-924-0659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/17/2018

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