Provider Demographics
NPI:1417283953
Name:MEDIC AZ QUALITY
Entity Type:Organization
Organization Name:MEDIC AZ QUALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:RAMADAN
Authorized Official - Last Name:ELSAYED
Authorized Official - Suffix:
Authorized Official - Credentials:DSC
Authorized Official - Phone:317-410-2858
Mailing Address - Street 1:11330 KNIGHTSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9151
Mailing Address - Country:US
Mailing Address - Phone:317-410-2868
Mailing Address - Fax:317-578-3638
Practice Address - Street 1:11330 KNIGHTSBRIDGE LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9151
Practice Address - Country:US
Practice Address - Phone:317-410-2868
Practice Address - Fax:317-578-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004402A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20-3807519OtherTAX ID