Basic Information
| Provider Information | |||||||||
| NPI: | 1386796563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAHLA IGHANI MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43130 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857333130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207223777 | ||||||||
| FaxNumber: | 5202966224 | ||||||||
| Practice Location | |||||||||
| Address1: | 9356 E RITA RD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857476302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206640800 | ||||||||
| FaxNumber: | 5206640828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 05/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | IGHANI | ||||||||
| AuthorizedOfficialFirstName: | SHAHLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5206640800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 33687 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 940967 | 05 | AZ | MEDICAID |