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NPI Code Detail

MEDICARE: DR. MAHDIEH FAZEL JEDLOWSKI MD

MEDICARE: DR. MAHDIEH FAZEL JEDLOWSKI MD
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
1183500000XPharmacistS021618AZ
2390200000XStudent in an Organized Health Care Education/Training Program
3390200000XStudent in an Organized Health Care Education/Training ProgramR78135AZ
4207N00000XDermatology Physician72061AZ

General Provider Information

NPI Number : 1679902449
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAHDIEH FAZEL JEDLOWSKI MD
Provider Business Mailing Address
First Line : 5301 E GRANT RD
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2805
Country : US
Telephone Number : 520-327-5461
Fax Number :
Provider Business Practice Location Address
First Line : 7165 N PIMA CANYON DR
Second Line :
City : TUCSON
State : AZ
Zip : 85718-1407
Country : US
Telephone Number : 520-694-8888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2013
Last Update Date : 09/09/2024

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