Provider Demographics
NPI:1801869219
Name:NADER, WALID (MD)
Entity type:Individual
Prefix:DR
First Name:WALID
Middle Name:
Last Name:NADER
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-290-1100
Mailing Address - Fax:520-290-8997
Practice Address - Street 1:899 N WILMOT RD STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1712
Practice Address - Country:US
Practice Address - Phone:520-290-1100
Practice Address - Fax:520-290-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4263313Medicaid
MI110Z310880OtherBLUE CROSS PIN
ON21030Medicare ID - Type Unspecified
MIMI1876001Medicare PIN
MI4263313Medicaid