Provider Demographics
NPI:1891761987
Name:MOKHASHI, MAHESH S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:S
Last Name:MOKHASHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5095
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:5823 W EUGIE AVE
Practice Address - Street 2:STE A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1276
Practice Address - Country:US
Practice Address - Phone:602-843-1265
Practice Address - Fax:602-843-1297
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29203207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ317047OtherGROUP MEDICAID NUMBER
AZ561391 01Medicaid
AZ120390OtherGROUP MEDICARE NUMBER
AZ561391-02Medicaid
H12081Medicare UPIN
AZ561391-02Medicaid
AZ317047OtherGROUP MEDICAID NUMBER