Provider Demographics
NPI:1710944327
Name:HORANI, MOHAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:HORANI
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:PO BOX 6746
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6746
Mailing Address - Country:US
Mailing Address - Phone:480-275-4938
Mailing Address - Fax:480-275-6626
Practice Address - Street 1:3250 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2379
Practice Address - Country:US
Practice Address - Phone:480-275-4938
Practice Address - Fax:480-275-6626
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32215207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859134Medicaid
AZI04897Medicare UPIN