Provider Demographics
NPI:1033453360
Name:PHOENIX INTERNAL MEDICINE GROUP PLC
Entity Type:Organization
Organization Name:PHOENIX INTERNAL MEDICINE GROUP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-718-1929
Mailing Address - Street 1:PO BOX 86459
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-6459
Mailing Address - Country:US
Mailing Address - Phone:409-718-1929
Mailing Address - Fax:
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:409-718-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty