Provider Demographics
NPI:1841287836
Name:CHILDREN'S DOCTOR, P.C.
Entity type:Organization
Organization Name:CHILDREN'S DOCTOR, P.C.
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:MD
Authorized Official - Phone:602-864-0211
Mailing Address - Street 1:5720 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2432
Mailing Address - Country:US
Mailing Address - Phone:602-864-0211
Mailing Address - Fax:602-864-9392
Practice Address - Street 1:5720 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2432
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:2005-10-04
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty