Provider Demographics
NPI:1114657517
Name:DADRA COMMUNITY CARE PC
Entity Type:Organization
Organization Name:DADRA COMMUNITY CARE PC
Other - Org Name:DADRA COMMUNITY CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IHTISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-901-9001
Mailing Address - Street 1:3706 HIGHWAY 95 STE 101
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8226
Mailing Address - Country:US
Mailing Address - Phone:928-201-9286
Mailing Address - Fax:928-219-4610
Practice Address - Street 1:3706 HIGHWAY 95 STE 101
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8226
Practice Address - Country:US
Practice Address - Phone:928-201-9286
Practice Address - Fax:928-219-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty