Provider Demographics
NPI:1447337647
Name:RAJAEI-TEHRANI, ALI (DO)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:RAJAEI-TEHRANI
Suffix:
Gender:M
Credentials:DO
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 41908
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1908
Mailing Address - Country:US
Mailing Address - Phone:602-973-3100
Mailing Address - Fax:602-973-0978
Practice Address - Street 1:7550 N 19TH AVE
Practice Address - Street 2:C-142
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7980
Practice Address - Country:US
Practice Address - Phone:602-973-3100
Practice Address - Fax:602-973-0978
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ159537Medicaid
AZ159537Medicaid