Provider Demographics
NPI:1881810224
Name:AZADI, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:AZADI
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 1:3983 E SCOUT PASS
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-5463
Mailing Address - Country:US
Mailing Address - Phone:623-271-8666
Mailing Address - Fax:623-271-9229
Practice Address - Street 1:14155 N 83RD AVE STE 138
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5652
Practice Address - Country:US
Practice Address - Phone:623-271-8666
Practice Address - Fax:623-271-9229
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38152207VG0400X, 207VF0040X
AZ36152207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY158647OtherSIHO-WS
KY50024904OtherPASSPORT PCP
KY000000610828OtherANTHEM
IN200943770Medicaid
KY000000859185OtherANTHEM-WS
KY3726876000OtherPASSPORT ADVANTAGE
KY50024900OtherPASSPORT SPECIALITY
KY3726874000OtherPASSPORT ADVANTAGE PCP
KY9393153OtherAETNA
KY3726870000OtherPASSPORT ADVANTAGE SPECIALITY
KY50024906OtherPASSPORT SPECIALITY
KY000000610873OtherANTHEM
KY0722553OtherMEDICARE - FOUNDATION
AZ335673Medicaid
KY50069587OtherPASSPORT-WS
KY7100074140Medicaid
KY50024906OtherPASSPORT SPECIALITY