Provider Demographics
NPI:1578272555
Name:ARIZONA PHYSICIAN GROUP PLLC
Entity Type:Organization
Organization Name:ARIZONA PHYSICIAN GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-420-1966
Mailing Address - Street 1:7959 N THORNYDALE RD # 89520
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1443
Mailing Address - Country:US
Mailing Address - Phone:520-420-1966
Mailing Address - Fax:866-733-1907
Practice Address - Street 1:6567 E CARONDELET DR STE 475
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-420-1966
Practice Address - Fax:866-733-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty