Provider Demographics
NPI:1588194112
Name:AL MARADNI, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:AL MARADNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AHMAD
Other - Middle Name:
Other - Last Name:AL MARADNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:111 E MCDOWELL RD
Mailing Address - Street 2:BANNER UNIVERSITY MEDICAL CENTERPHOENIX LL2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1216
Mailing Address - Country:US
Mailing Address - Phone:602-839-2792
Mailing Address - Fax:
Practice Address - Street 1:111 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-8500
Practice Address - Country:US
Practice Address - Phone:602-839-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272064207R00000X
AZ272064207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1588194112Medicaid
AZ1588194112Medicaid