Provider Demographics
NPI:1376836452
Name:MAKARAWO, TAFADZWA P (MD)
Entity Type:Individual
Prefix:
First Name:TAFADZWA
Middle Name:P
Last Name:MAKARAWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-296-1452
Mailing Address - Fax:602-774-3262
Practice Address - Street 1:18275 N 59TH AVE STE M-176
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-993-2622
Practice Address - Fax:602-993-2922
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ54564208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ295306Medicaid