Provider Demographics
NPI:1144616236
Name:AMD INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:AMD INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFEEQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-345-2888
Mailing Address - Street 1:1200 E PLACITA ARDILLA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2910
Mailing Address - Country:US
Mailing Address - Phone:612-345-2888
Mailing Address - Fax:
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:STE 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:612-345-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48003261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care