Basic Information
| Provider Information | |||||||||
| NPI: | 1750622643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRANESH | ||||||||
| FirstName: | GHASSAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42210 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850802210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232667770 | ||||||||
| FaxNumber: | 6233224639 | ||||||||
| Practice Location | |||||||||
| Address1: | 7350 E SPEEDWAY BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857101365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026855211 | ||||||||
| FaxNumber: | 6026855325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2013 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 53677 | AZ | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 53677 | AZ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | T652278001906 | 01 | MI | DRIVING LICENSE | OTHER |