Provider Demographics
NPI:1265682850
Name:ARIZONA PHYSICAL MEDICINE AND REHABILITATION PC
Entity Type:Organization
Organization Name:ARIZONA PHYSICAL MEDICINE AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:IQBAL
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-878-7425
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85280-0036
Mailing Address - Country:US
Mailing Address - Phone:480-878-7425
Mailing Address - Fax:480-207-1025
Practice Address - Street 1:5690 W CHANDLER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3356
Practice Address - Country:US
Practice Address - Phone:480-878-7425
Practice Address - Fax:480-207-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40368208100000X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ376403Medicaid