Provider Demographics
NPI:1760622344
Name:ABDUL MEMON, MD, PLLC
Entity Type:Organization
Organization Name:ABDUL MEMON, MD, PLLC
Other - Org Name:CARDIOVASCULAR ASSOCIATES OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-793-3747
Mailing Address - Street 1:5882 S HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9455
Mailing Address - Country:US
Mailing Address - Phone:928-793-3747
Mailing Address - Fax:928-793-3747
Practice Address - Street 1:5882 S HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9455
Practice Address - Country:US
Practice Address - Phone:928-793-3747
Practice Address - Fax:928-793-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24282207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128910OtherMEDICARE PTAN
G31768Medicare UPIN