Provider Demographics
NPI:1265554612
Name:THE PEDIATRIC ENDOCRINE DIABETES CLINIC PC
Entity type:Organization
Organization Name:THE PEDIATRIC ENDOCRINE DIABETES CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC ENDOCRINE
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-692-7926
Mailing Address - Street 1:333 W THOMAS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4417
Mailing Address - Country:US
Mailing Address - Phone:602-692-7926
Mailing Address - Fax:602-266-9660
Practice Address - Street 1:333 W THOMAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4417
Practice Address - Country:US
Practice Address - Phone:602-692-7926
Practice Address - Fax:602-266-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ303552080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235191727OtherINDIVIUAL NPI
1235191727OtherINDIVIUAL NPI