Provider Demographics
NPI:1558597302
Name:ALSHAM ENDOCRINOLOGY
Entity Type:Organization
Organization Name:ALSHAM ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:HORANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-275-4938
Mailing Address - Street 1:PO BOX 6746
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6746
Mailing Address - Country:US
Mailing Address - Phone:480-275-4938
Mailing Address - Fax:480-275-6626
Practice Address - Street 1:3250 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2379
Practice Address - Country:US
Practice Address - Phone:480-275-4938
Practice Address - Fax:480-275-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32215207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859134Medicaid