Provider Demographics
NPI:1144294109
Name:SHARIFI TAKIEH, SEYED MOHSEN (MD)
Entity type:Individual
Prefix:DR
First Name:SEYED MOHSEN
Middle Name:
Last Name:SHARIFI TAKIEH
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 1:3850 E BASELINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4403
Mailing Address - Country:US
Mailing Address - Phone:480-924-0006
Mailing Address - Fax:480-924-0659
Practice Address - Street 1:3850 E BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4403
Practice Address - Country:US
Practice Address - Phone:480-924-0006
Practice Address - Fax:480-924-0659
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33949207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ958465Medicaid
AZ958465Medicaid
AZG25900Medicare UPIN