Provider Demographics
NPI:1942353792
Name:SCOTTSDALE INTERNAL MEDICINE CONSULTANTS INC
Entity Type:Organization
Organization Name:SCOTTSDALE INTERNAL MEDICINE CONSULTANTS INC
Other - Org Name:SCOTTSDALE PHEONIX INTERNAL MEDICINE AND FAMILY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZULFIQAR
Authorized Official - Middle Name:UDDIN
Authorized Official - Last Name:FAROOQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-905-0000
Mailing Address - Street 1:PO BOX 2890
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2890
Mailing Address - Country:US
Mailing Address - Phone:480-341-2372
Mailing Address - Fax:480-436-5193
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-341-2372
Practice Address - Fax:480-436-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24737207R00000X
AZ24639207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ365701-02Medicaid
AZ365701-02Medicaid
70294Medicare PIN