Provider Demographics
NPI:1467763698
Name:ARIZONA BARIATRIC AND FAMILY MEDICINE PLC
Entity Type:Organization
Organization Name:ARIZONA BARIATRIC AND FAMILY MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MUNIR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-371-4164
Mailing Address - Street 1:PO BOX 12703
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0029
Mailing Address - Country:US
Mailing Address - Phone:480-371-4164
Mailing Address - Fax:602-513-7456
Practice Address - Street 1:2152 S VINEYARD
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6871
Practice Address - Country:US
Practice Address - Phone:480-371-4164
Practice Address - Fax:602-513-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2452207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ529966Medicaid
AZP-1550668-1OtherPLC REGISTRATION
AZZ140000Medicare PIN