Provider Demographics
NPI:1093781346
Name:MEMON, ABDUL Q (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:Q
Last Name:MEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5882 S HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9455
Mailing Address - Country:US
Mailing Address - Phone:928-793-3747
Mailing Address - Fax:928-793-3745
Practice Address - Street 1:5882 S HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501
Practice Address - Country:US
Practice Address - Phone:928-793-3747
Practice Address - Fax:928-793-3745
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24282174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z1340OtherHEALTHNET
AZ362450OtherSTATE AHCCCS
AZ6013273OtherCIGNA HEALTHCARE
AZ36245001OtherMERCYCARE
AZ6013273OtherCIGNA
AZ7765048OtherAETNA HEALTHCARE
AZAZ0769860OtherBC/BS OF ARIZONA
AZ362450Medicaid
AZ362450Medicaid