Provider Demographics
NPI:1235468703
Name:QUADRI, MIR M A (MD)
Entity type:Individual
Prefix:
First Name:MIR
Middle Name:M A
Last Name:QUADRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIR
Other - Middle Name:MASOOD ALI
Other - Last Name:QUADRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2900 W HIGHLAND ST
Mailing Address - Street 2:APT # 283
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7833
Mailing Address - Country:US
Mailing Address - Phone:847-414-5573
Mailing Address - Fax:
Practice Address - Street 1:2900 W HIGHLAND ST
Practice Address - Street 2:APT # 283
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7833
Practice Address - Country:US
Practice Address - Phone:847-414-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR 70671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139007Medicare PIN