Provider Demographics
NPI:1124201777
Name:COLORECTAL CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:COLORECTAL CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:TARAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-240-7391
Mailing Address - Street 1:PO BOX 4023
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4023
Mailing Address - Country:US
Mailing Address - Phone:480-240-7391
Mailing Address - Fax:480-240-7391
Practice Address - Street 1:9475 E IRONWOOD SQUARE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4576
Practice Address - Country:US
Practice Address - Phone:480-240-7391
Practice Address - Fax:480-240-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34222208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106286Medicare PIN