Provider Demographics
NPI:1285897991
Name:YUSUPOV, IGOR RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:RICHARD
Last Name:YUSUPOV
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5111
Mailing Address - Country:US
Mailing Address - Phone:602-266-2272
Mailing Address - Fax:602-266-2927
Practice Address - Street 1:11000 N SCOTTSDALE RD STE 240
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5111
Practice Address - Country:US
Practice Address - Phone:602-266-2272
Practice Address - Fax:602-266-2927
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44305207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ598763Medicaid
AZZ146455Medicare PIN