Provider Demographics
NPI:1114545506
Name:MIRAGE PODIATRY FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:MIRAGE PODIATRY FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMMAD
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-358-7970
Mailing Address - Street 1:9250 N 3RD ST STE 3020
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2425
Mailing Address - Country:US
Mailing Address - Phone:480-939-3440
Mailing Address - Fax:480-939-3448
Practice Address - Street 1:9250 N 3RD ST STE 3020
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2425
Practice Address - Country:US
Practice Address - Phone:480-939-3440
Practice Address - Fax:480-939-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164752283Medicaid
AZ1164809711Medicaid