Provider Demographics
NPI:1275917064
Name:BOSHARA, ANDREW ROSHDY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROSHDY
Last Name:BOSHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W THOMAS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4220
Mailing Address - Country:US
Mailing Address - Phone:602-406-4000
Mailing Address - Fax:602-406-6498
Practice Address - Street 1:500 W THOMAS RD STE 850
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4218
Practice Address - Country:US
Practice Address - Phone:602-406-1150
Practice Address - Fax:602-406-1159
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301504386207R00000X, 207RA0001X, 207RC0000X
AZ65310207RA0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163453Medicaid