Provider Demographics
NPI:1730624693
Name:PEDRAM AMANI, MD, PLLC
Entity type:Organization
Organization Name:PEDRAM AMANI, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-308-2472
Mailing Address - Street 1:14747 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 111-200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6015 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1213
Practice Address - Country:US
Practice Address - Phone:623-344-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ508412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120431Medicaid