Provider Demographics
NPI:1558583989
Name:KISANA, MASOOD AHMAD
Entity Type:Individual
Prefix:
First Name:MASOOD
Middle Name:AHMAD
Last Name:KISANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MASOOD
Other - Middle Name:AHMAD
Other - Last Name:KISANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:832 N BENSON LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3411
Mailing Address - Country:US
Mailing Address - Phone:602-750-1587
Mailing Address - Fax:
Practice Address - Street 1:925 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2502
Practice Address - Country:US
Practice Address - Phone:602-239-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine