Provider Demographics
NPI:1265536536
Name:AZ INSTITUTE OF NEUROLOGY & POLYSOMOGRAPHY P C
Entity type:Organization
Organization Name:AZ INSTITUTE OF NEUROLOGY & POLYSOMOGRAPHY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:U
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-423-2046
Mailing Address - Street 1:P.O. BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-1225
Mailing Address - Country:US
Mailing Address - Phone:520-423-0208
Mailing Address - Fax:
Practice Address - Street 1:1653 E MCMURRAY BLVD
Practice Address - Street 2:SUITE 139
Practice Address - City:CADA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-423-2046
Practice Address - Fax:520-423-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ504375OtherAHCCCS
AZH25698Medicare UPIN