Provider Demographics
NPI:1518937507
Name:ASADI, SHAHRAM D (DO)
Entity Type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:D
Last Name:ASADI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5540
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5540
Mailing Address - Country:US
Mailing Address - Phone:480-805-8855
Mailing Address - Fax:480-805-8844
Practice Address - Street 1:5620 W THUNDERBIRD RD STE E5
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4651
Practice Address - Country:US
Practice Address - Phone:480-805-8855
Practice Address - Fax:480-805-8844
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ010453207R00000X
COCDRH.0038909208M00000X
TXK3070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89483766Medicaid
COASB64470OtherANTHEM BCBS
P00352065OtherRAILROAD MEDICARE
COC806436Medicare PIN
CO89483766Medicaid