Provider Demographics
NPI:1467405357
Name:DARDARI, MOHAMMAD K (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:K
Last Name:DARDARI
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 1:3202 E GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4548
Mailing Address - Country:US
Mailing Address - Phone:602-325-5577
Mailing Address - Fax:602-357-1486
Practice Address - Street 1:3202 E GREENWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4548
Practice Address - Country:US
Practice Address - Phone:602-325-5577
Practice Address - Fax:602-357-1486
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113140207R00000X
AZ55230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113140Medicaid
ILK15968Medicare ID - Type Unspecified