Provider Demographics
NPI:1104840693
Name:RAMDANI, WYSSEM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WYSSEM
Middle Name:A
Last Name:RAMDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5555 W. THUNDERBIRD ROAD
Mailing Address - Street 2:BANNER THUNDERBIRD MEDICAL CENTER
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-865-2627
Mailing Address - Fax:602-865-2632
Practice Address - Street 1:5555 W. THUNDERBIRD ROAD
Practice Address - Street 2:BANNER THUNDERBIRD MEDICAL CENTER
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-865-2627
Practice Address - Fax:602-865-2632
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081343207R00000X
AZ42149207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII03713Medicare UPIN
AZZ140114Medicare PIN