Provider Demographics
NPI:1740240027
Name:DOORANI, TARIQ (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:DOORANI
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 1:2401 W GLENDALE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7673
Mailing Address - Country:US
Mailing Address - Phone:480-828-9582
Mailing Address - Fax:
Practice Address - Street 1:2401 W GLENDALE AVE STE 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7673
Practice Address - Country:US
Practice Address - Phone:602-772-5770
Practice Address - Fax:602-772-5771
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000407692084N0400X
AZ414122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8293938Medicaid
AZZ129949Medicare PIN
WAH56794Medicare UPIN
WA8293938Medicaid
WAGAB26480Medicare PIN