Provider Demographics
NPI:1689868903
Name:MEHDI K. MAZAHERI MD, PC
Entity Type:Organization
Organization Name:MEHDI K. MAZAHERI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAZAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-951-4343
Mailing Address - Street 1:5725 N SCOTTSDALE RD
Mailing Address - Street 2:#150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5908
Mailing Address - Country:US
Mailing Address - Phone:480-951-4343
Mailing Address - Fax:
Practice Address - Street 1:5725 N SCOTTSDALE RD
Practice Address - Street 2:#150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5908
Practice Address - Country:US
Practice Address - Phone:480-951-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74949Medicare PIN