Provider Demographics
NPI:1689876252
Name:MAREADY, DOUGLAS MILAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MILAN
Last Name:MAREADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4135 S POWER RD STE 113
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3625
Mailing Address - Country:US
Mailing Address - Phone:480-626-2444
Mailing Address - Fax:480-409-2987
Practice Address - Street 1:4135 S POWER RD STE 113
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3625
Practice Address - Country:US
Practice Address - Phone:480-626-2444
Practice Address - Fax:480-409-2987
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ331408Medicaid
1689876252OtherNPI