Provider Demographics
NPI:1902895931
Name:KAMAL, AASIM (MD)
Entity Type:Individual
Prefix:DR
First Name:AASIM
Middle Name:
Last Name:KAMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 W NORTHERN AVE STE C203
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4929
Mailing Address - Country:US
Mailing Address - Phone:602-942-2020
Mailing Address - Fax:602-942-2121
Practice Address - Street 1:2226 W NORTHERN AVE STE C203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4929
Practice Address - Country:US
Practice Address - Phone:602-942-2020
Practice Address - Fax:602-942-2121
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30886207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ733627Medicaid
AZ611627Medicaid
AZ733627Medicaid
AZZ144433Medicare PIN