Provider Demographics
NPI:1013992817
Name:BANIRIAH, KATAYOUN (DO)
Entity Type:Individual
Prefix:
First Name:KATAYOUN
Middle Name:
Last Name:BANIRIAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 E THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3556
Mailing Address - Country:US
Mailing Address - Phone:480-699-7004
Mailing Address - Fax:480-699-6129
Practice Address - Street 1:4845 E THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3556
Practice Address - Country:US
Practice Address - Phone:480-699-7004
Practice Address - Fax:480-699-6129
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080085526OtherRAILROAD MEDICARE
AZ86080015085259A218OtherTRIWEST
AZ413138Medicaid
AZ080085526OtherRAILROAD MEDICARE
AZ080085526OtherRAILROAD MEDICARE