Provider Demographics
NPI:1235115130
Name:MOHAMMADI MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MOHAMMADI MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAEID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-968-2990
Mailing Address - Street 1:9026 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1817
Mailing Address - Country:US
Mailing Address - Phone:480-323-0838
Mailing Address - Fax:480-588-6212
Practice Address - Street 1:2039 S MILL AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2137
Practice Address - Country:US
Practice Address - Phone:480-968-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty