Provider Demographics
NPI:1457559486
Name:CHILDREN'S DOCTOR, PC
Entity Type:Organization
Organization Name:CHILDREN'S DOCTOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERAMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:20101
Authorized Official - Phone:602-864-0211
Mailing Address - Street 1:1728 W GLENDALE AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8860
Mailing Address - Country:US
Mailing Address - Phone:602-864-0211
Mailing Address - Fax:602-864-9392
Practice Address - Street 1:1728 W GLENDALE AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8860
Practice Address - Country:US
Practice Address - Phone:602-864-0211
Practice Address - Fax:602-864-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren