Provider Demographics
NPI:1003595364
Name:VOYAGE MEDICAL PRIMARY CARE
Entity Type:Organization
Organization Name:VOYAGE MEDICAL PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:IMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-685-0930
Mailing Address - Street 1:2402 S RURAL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2455
Mailing Address - Country:US
Mailing Address - Phone:480-516-5819
Mailing Address - Fax:
Practice Address - Street 1:1130 W GROVE AVE STE 115
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4942
Practice Address - Country:US
Practice Address - Phone:480-685-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty