Basic Information
| Provider Information | |||||||||
| NPI: | 1841460748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AYAAZ ISMAIL 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: | 6130 N LA CHOLLA BLVD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857413557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205755003 | ||||||||
| FaxNumber: | 5202966224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2008 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | ISMAIL | ||||||||
| AuthorizedOfficialFirstName: | AYAAZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER OF PRACTICE | ||||||||
| AuthorizedOfficialTelephone: | 5207223777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 29921 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 319232 | 05 | AZ | MEDICAID |