Provider Demographics
NPI:1811320203
Name:INFECTIOUS DISEASE CONSULTANTS OF ARIZONA
Entity type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMUTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-969-1281
Mailing Address - Street 1:3303 S LINDSAY RD
Mailing Address - Street 2:STE 123
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1503
Mailing Address - Country:US
Mailing Address - Phone:917-969-1281
Mailing Address - Fax:480-821-9555
Practice Address - Street 1:19841 N 27TH AVE STE 403
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:602-439-0274
Practice Address - Fax:480-821-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35819207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35819OtherLICENSE
AZ228441Medicaid