Provider Demographics
NPI:1700062650
Name:LADHA, SHIRAZ H (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRAZ
Middle Name:H
Last Name:LADHA
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 1:14001 N 7TH ST
Mailing Address - Street 2:BUILDING G, SUITE 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4382
Mailing Address - Country:US
Mailing Address - Phone:602-298-6930
Mailing Address - Fax:602-298-6918
Practice Address - Street 1:14001 N 7TH ST
Practice Address - Street 2:BUILDING G, SUITE 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4382
Practice Address - Country:US
Practice Address - Phone:602-298-6930
Practice Address - Fax:602-298-6918
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ282038Medicaid
AZ282038Medicaid