Provider Demographics
NPI:1235447848
Name:MOHAMMAD JAMIL PC
Entity Type:Organization
Organization Name:MOHAMMAD JAMIL PC
Other - Org Name:ICARE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:I
Authorized Official - Last Name:JAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-670-7772
Mailing Address - Street 1:8765 W KELTON LN STE 110
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5008
Mailing Address - Country:US
Mailing Address - Phone:623-670-7772
Mailing Address - Fax:623-444-2361
Practice Address - Street 1:8765 W KELTON LN STE 110
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5008
Practice Address - Country:US
Practice Address - Phone:623-670-7772
Practice Address - Fax:623-444-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ554820Medicaid
AZ554820Medicaid