Basic Information
| Provider Information | |||||||||
| NPI: | 1851490460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZHARUDDIN | ||||||||
| FirstName: | MUHAMMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13400 E SHEA BLVD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852595452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803018000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5777 E MAYO BLVD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850544502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803421387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 41194 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | 2001017143 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00888848 | 01 | AZ | RAILROAD MEDICARE | OTHER | 459408 | 05 | AZ | MEDICAID |