Basic Information
| Provider Information | |||||||||
| NPI: | 1245494046 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AJMAL | ||||||||
| FirstName: | ADNAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 N CENTRAL AVE STE 1001 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD STE 900B | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 4301104590 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | 4301104590 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 50594 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 55957 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 110091667A | 05 | MA | MEDICAID |