Provider Demographics
NPI:1396717484
Name:HAYYERI, MARZBAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARZBAN
Middle Name:MICHAEL
Last Name:HAYYERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1728 W GLENDALE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8860
Mailing Address - Country:US
Mailing Address - Phone:602-242-1556
Mailing Address - Fax:602-242-3099
Practice Address - Street 1:1728 W GLENDALE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8860
Practice Address - Country:US
Practice Address - Phone:602-775-5300
Practice Address - Fax:602-775-5301
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28018208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ499865OtherAHCCCS NUMBER
AZMICA-48081OtherMICA
AZ28018OtherAZ LICENSE
AZBH6375807OtherDEA
AZMICA-48081OtherMICA
AZ28018OtherAZ LICENSE