Provider Demographics
NPI:1629002803
Name:HAFEZ AZADEH MD PLLC
Entity Type:Organization
Organization Name:HAFEZ AZADEH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAFEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-596-8525
Mailing Address - Street 1:PO BOX 26904
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-6904
Mailing Address - Country:US
Mailing Address - Phone:480-596-8525
Mailing Address - Fax:480-596-8522
Practice Address - Street 1:5555 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:480-596-8525
Practice Address - Fax:480-596-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW8852OtherHEALTHNET
AZ0776550OtherBLUE CROSS BLUE SHIELD
AZP00268061OtherRAILROAD MEDICARE
AZ874463Medicaid
AZP00268061OtherRAILROAD MEDICARE
AZZ104560Medicare PIN