Provider Demographics
NPI:1215908397
Name:BAGHDADI, HOMEIRA (MD)
Entity type:Individual
Prefix:
First Name:HOMEIRA
Middle Name:
Last Name:BAGHDADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W ORANGE GROVE RD
Mailing Address - Street 2:STE. 604
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1139
Mailing Address - Country:US
Mailing Address - Phone:520-219-6100
Mailing Address - Fax:520-219-6119
Practice Address - Street 1:2001 W ORANGE GROVE RD
Practice Address - Street 2:STE. 604
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1139
Practice Address - Country:US
Practice Address - Phone:520-219-6100
Practice Address - Fax:520-219-6119
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG70301Medicare UPIN
AZ81968Medicare ID - Type Unspecified