Provider Demographics
NPI:1154430205
Name:GRAD, RONI (MD)
Entity type:Individual
Prefix:
First Name:RONI
Middle Name:
Last Name:GRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:
Practice Address - Street 1:535 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2600
Practice Address - Country:US
Practice Address - Phone:520-694-9937
Practice Address - Fax:520-694-9917
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL214372080P0214X
AZ382102080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ277071Medicaid
AL000076613Medicaid
AL000076400Medicaid
000076613Medicare ID - Type Unspecified
AL000076613Medicaid
AZZ122270Medicare PIN
AL000076400Medicaid