Provider Demographics
NPI:1083360176
Name:MAXAMED, MAXAMED
Entity Type:Individual
Prefix:
First Name:MAXAMED
Middle Name:
Last Name:MAXAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 E RANCH CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8609
Mailing Address - Country:US
Mailing Address - Phone:512-909-9119
Mailing Address - Fax:
Practice Address - Street 1:2966 E RANCH CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8609
Practice Address - Country:US
Practice Address - Phone:512-909-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)