Provider Demographics
NPI:1871799544
Name:TAKI, RAAD M (MD)
Entity type:Individual
Prefix:DR
First Name:RAAD
Middle Name:M
Last Name:TAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:M
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4580 E CAMP LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1282
Mailing Address - Country:US
Mailing Address - Phone:520-881-3232
Mailing Address - Fax:520-881-3535
Practice Address - Street 1:4580 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1282
Practice Address - Country:US
Practice Address - Phone:520-881-3232
Practice Address - Fax:520-881-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27306282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619942OtherAHCCCS