Provider Demographics
NPI:1558384966
Name:HALEPOTA, MAQBOOL ALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MAQBOOL
Middle Name:ALAM
Last Name:HALEPOTA
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 1:5601 W EUGIE
Mailing Address - Street 2:STE 105
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304
Mailing Address - Country:US
Mailing Address - Phone:602-978-6255
Mailing Address - Fax:623-478-1534
Practice Address - Street 1:5601 W EUGIE AVE STE 106
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1256
Practice Address - Country:US
Practice Address - Phone:602-978-6255
Practice Address - Fax:602-564-9286
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31459174400000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ787426Medicaid
AZG32755Medicare UPIN
AZ787426Medicaid