MEDICARE: MISBAH W. ALTAF 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
1	207Q00000X	Family Medicine Physician	PT12461	ND
2	207Q00000X	Family Medicine Physician	RL11228	ND
3	207Q00000X	Family Medicine Physician	52163	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790917052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISBAH W. ALTAF MD

Provider Business Mailing Address
First Line	:	3101 N CENTRAL AVE STE 550
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2635
Country	:	US
Telephone Number	:	602-230-7373
Fax Number	:	602-682-7455

Provider Business Practice Location Address
First Line	:	750 E THUNDERBIRD RD STE 1-3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5306
Country	:	US
Telephone Number	:	602-230-7373
Fax Number	:	602-218-6383

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

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	11/17/2023

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Directions to “ MISBAH W. ALTAF MD” Practice Location

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