Provider Demographics
NPI:1386890556
Name:AMINI, ALBERT (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:AMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 S DOBSON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6157
Mailing Address - Country:US
Mailing Address - Phone:602-582-5233
Mailing Address - Fax:623-208-5075
Practice Address - Street 1:1100 S DOBSON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6157
Practice Address - Country:US
Practice Address - Phone:602-582-5233
Practice Address - Fax:623-208-5075
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ47277208600000X
WI603422086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386890556Medicaid