Provider Demographics
NPI:1447269220
Name:BEKTESHI, EDGAR SELAUDIN (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:SELAUDIN
Last Name:BEKTESHI
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:PO BOX 20610
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0610
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-296-7665
Practice Address - Street 1:290 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7631
Practice Address - Country:US
Practice Address - Phone:480-759-1027
Practice Address - Fax:480-759-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430926207R00000X
AZ35734207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1573891OtherGATEWAY-WMG
PA102195398Medicaid
PA212124OtherJOHNS HOPKINS
PA50080063OtherCAPITAL BLUE CROSS-WMG
PA250000OtherUNISON-WMG
PA7292807OtherAETNA
MD944257OtherCAREFIRST MD BCBS
PA20078624OtherAMERIHEALTH MERCY-WMG
AZ959056Medicaid
PA119589OtherGEISINGER HEALTH PLAN
PA2066093OtherHIGHMARK BLUE SHIELD
I60996Medicare UPIN
PA130571FLTMedicare PIN
PA102195398Medicaid