Provider Demographics
NPI:1225015159
Name:SHIRAZ H LADHA MD PC
Entity Type:Organization
Organization Name:SHIRAZ H LADHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRAZ
Authorized Official - Middle Name:H
Authorized Official - Last Name:LADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-298-6930
Mailing Address - Street 1:14001 N 7TH ST
Mailing Address - Street 2:SUITE G114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4382
Mailing Address - Country:US
Mailing Address - Phone:602-298-6930
Mailing Address - Fax:602-298-6918
Practice Address - Street 1:14001 N 7TH ST
Practice Address - Street 2:SUITE G114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4382
Practice Address - Country:US
Practice Address - Phone:602-298-6930
Practice Address - Fax:602-298-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16757261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ282038Medicaid
MNI17296Medicare UPIN
AZE03095Medicare UPIN