Basic Information
| Provider Information | |||||||||
| NPI: | 1285796821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAHMD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16038 S 35TH WAY | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026189127 | ||||||||
| FaxNumber: | 4808219555 | ||||||||
| Practice Location | |||||||||
| Address1: | 6644 E BAYWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026189127 | ||||||||
| FaxNumber: | 4807855314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | OJHA HAMMAD | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6026189127 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | 31982 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 207R00000X | 31982 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 806432 | 05 | AZ | MEDICAID |