Provider Demographics
NPI:1871861617
Name:EASAPOUR CHESHANI, MILA (MD)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:EASAPOUR CHESHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR
Mailing Address - Street 2:STE 125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4583
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-819-6115
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:STE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4583
Practice Address - Country:US
Practice Address - Phone:480-455-3000
Practice Address - Fax:866-819-6115
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45023207QG0300X
CAA117239207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ782627Medicaid
AZ782627Medicaid