Provider Demographics
NPI:1942253836
Name:BARAZANJI FAMILY MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:BARAZANJI FAMILY MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAJED
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARAZANJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-440-6622
Mailing Address - Street 1:PO BOX 71602
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-0602
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:515-244-5570
Practice Address - Street 1:1701 22ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1443
Practice Address - Country:US
Practice Address - Phone:515-440-6622
Practice Address - Fax:515-440-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2063693Medicaid
IAI15281Medicare PIN
IAE57954Medicare UPIN
IA6416200001Medicare NSC