Provider Demographics
NPI:1720512171
Name:RAZAVI, MIR-MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MIR-MUHAMMAD
Middle Name:
Last Name:RAZAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOMC ATTN HOSPITALISTS
Mailing Address - Street 2:1405 S ALMA SCHOOL RD
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286
Mailing Address - Country:US
Mailing Address - Phone:480-256-7420
Mailing Address - Fax:480-646-3826
Practice Address - Street 1:BOMC ATTN HOSPITALISTS
Practice Address - Street 2:1405 S ALMA SCHOOL RD
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-256-7420
Practice Address - Fax:480-646-3826
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61625207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program