Provider Demographics
NPI:1144338609
Name:VISHTEH, ARASH GIANCARLO (MD)
Entity type:Individual
Prefix:
First Name:ARASH
Middle Name:GIANCARLO
Last Name:VISHTEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:GIANNI
Other - Last Name:VISHTEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44752
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4752
Mailing Address - Country:US
Mailing Address - Phone:480-827-2200
Mailing Address - Fax:480-827-0318
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:480-827-2200
Practice Address - Fax:480-827-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24746207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ467474Medicaid
AZAZ68202Medicare ID - Type Unspecified
AZ467474Medicaid