Provider Demographics
NPI:1467659193
Name:AUDI, RAMIZ (RAMIZ AUDI)
Entity Type:Individual
Prefix:
First Name:RAMIZ
Middle Name:
Last Name:AUDI
Suffix:
Gender:M
Credentials:RAMIZ AUDI
Other - Prefix:
Other - First Name:RAMIZ
Other - Middle Name:
Other - Last Name:AUDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1915 E CHANDLER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5117
Mailing Address - Country:US
Mailing Address - Phone:480-306-5151
Mailing Address - Fax:480-306-4648
Practice Address - Street 1:1915 E CHANDLER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5117
Practice Address - Country:US
Practice Address - Phone:480-306-5151
Practice Address - Fax:480-306-4648
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012564422084P0800X
ORLL16619390200000X
AZ550982084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05149OtherGROUP PTAN
AZ330609Medicaid