Provider Demographics
NPI:1306830948
Name:TARIQ, ARSHAD (MD)
Entity Type:Individual
Prefix:
First Name:ARSHAD
Middle Name:
Last Name:TARIQ
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 1:3636 N STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0514
Mailing Address - Country:US
Mailing Address - Phone:928-757-3636
Mailing Address - Fax:928-757-7224
Practice Address - Street 1:3636 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0514
Practice Address - Country:US
Practice Address - Phone:928-757-3636
Practice Address - Fax:928-757-7224
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ173055Medicaid
F96285Medicare UPIN
AZ173055Medicaid