Provider Demographics
NPI:1912962549
Name:PARACHA, MUNAWAR AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNAWAR
Middle Name:AHMAD
Last Name:PARACHA
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 1:1708 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0927
Mailing Address - Country:US
Mailing Address - Phone:928-757-7100
Mailing Address - Fax:928-757-7255
Practice Address - Street 1:1708 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0927
Practice Address - Country:US
Practice Address - Phone:928-757-7100
Practice Address - Fax:928-757-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430075Medicaid
AZ29422Medicare ID - Type Unspecified
AZG58407Medicare UPIN