Provider Demographics
NPI:1528167947
Name:ISMAIL, AYAAZ (MD)
Entity type:Individual
Prefix:
First Name:AYAAZ
Middle Name:
Last Name:ISMAIL
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 1:7150 SMOKE RANCH RD # 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3157
Mailing Address - Country:US
Mailing Address - Phone:520-948-9480
Mailing Address - Fax:702-485-5101
Practice Address - Street 1:7150 SMOKE RANCH RD # 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-948-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29921207RG0100X
NV16970207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642365Medicaid
AZ100015863OtherRR MEDICARE
AZ1528167947OtherINDIVIDUAL
H56101Medicare UPIN
AZD43945Medicare UPIN
AZZ68493Medicare PIN