Provider Demographics
NPI:1104019413
Name:ADULT GASTROENTEROLOGY, P.L.L.C.
Entity Type:Organization
Organization Name:ADULT GASTROENTEROLOGY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZYADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-550-6354
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3026
Practice Address - Street 1:2236 W BETHANY HOME RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1934
Practice Address - Country:US
Practice Address - Phone:602-550-6354
Practice Address - Fax:602-242-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30881207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118617Medicare PIN
AZDN02088Medicare PIN