Provider Demographics
NPI:1154773463
Name:MARWAN GHAZOUL MD PC
Entity type:Organization
Organization Name:MARWAN GHAZOUL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-708-9276
Mailing Address - Street 1:4240 E MARLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3960
Mailing Address - Country:US
Mailing Address - Phone:602-708-9276
Mailing Address - Fax:
Practice Address - Street 1:4240 E MARLETTE AVE
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3960
Practice Address - Country:US
Practice Address - Phone:602-708-9276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18744208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1558362491OtherINDIVIDUAL NPI