Provider Demographics
NPI:1669444246
Name:JALALZAI, WAHEED (MD)
Entity Type:Individual
Prefix:DR
First Name:WAHEED
Middle Name:
Last Name:JALALZAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17310 WRIGHT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2405
Mailing Address - Country:US
Mailing Address - Phone:833-228-6889
Mailing Address - Fax:877-853-0376
Practice Address - Street 1:31 SUNSET PARK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2742
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ328762085R0202X
ND162112085R0202X
WY12513C2085R0202X
TXP45812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0221810OtherBCBSAZ
AZ867947Medicaid
AZZ81754Medicare PIN
AZ1Z7086OtherHEALTH NET OF AZ
AZZ81762Medicare PIN
I06170Medicare UPIN
AZZ121400Medicare PIN
AZZ25034Medicare PIN
AZZ81756Medicare PIN
AZP00146046Medicare PIN
AZZ121137Medicare PIN