Provider Demographics
NPI:1689869182
Name:MALAKI, AFSHIN (MD)
Entity Type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:MALAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AFSHIN
Other - Middle Name:MALAKI
Other - Last Name:ROODPASHTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13995 W STATLER BLVD
Mailing Address - Street 2:BANNER SURPRISE HEALTH CENTER
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5501
Mailing Address - Country:US
Mailing Address - Phone:623-478-3100
Mailing Address - Fax:
Practice Address - Street 1:13995 W STATLER BLVD
Practice Address - Street 2:BANNER SURPRISE HEALTH CENTER
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5501
Practice Address - Country:US
Practice Address - Phone:623-478-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37834207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1689869182Medicaid