Basic Information
| Provider Information | |||||||||
| NPI: | 1548469273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HABIBZADEH | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | REZA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 W ST. MARY'S RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206281400 | ||||||||
| FaxNumber: | 5206284863 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 N SILVERBELL RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203961370 | ||||||||
| FaxNumber: | 5203961375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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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 | 207R00000X | 37223 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 37223 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 37223 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 828491 | 05 | AZ | MEDICAID |