Provider Demographics
NPI:1750180071
Name:MIRJAT, DUREALI
Entity type:Individual
Prefix:
First Name:DUREALI
Middle Name:
Last Name:MIRJAT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 E RIO SALADO PKWY UNIT 2015
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-0005
Mailing Address - Country:US
Mailing Address - Phone:708-205-2853
Mailing Address - Fax:
Practice Address - Street 1:1979 E RIO SALADO PKWY UNIT 2015
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-0005
Practice Address - Country:US
Practice Address - Phone:708-205-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program