Provider Demographics
NPI:1548469273
Name:HABIBZADEH, MOHAMMAD REZA (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:REZA
Last Name:HABIBZADEH
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 1:1815 W ST. MARY'S RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2653
Mailing Address - Country:US
Mailing Address - Phone:520-628-1400
Mailing Address - Fax:520-628-4863
Practice Address - Street 1:445 N SILVERBELL RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2686
Practice Address - Country:US
Practice Address - Phone:520-396-1370
Practice Address - Fax:520-396-1375
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37223207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ828491Medicaid
AZ828491Medicaid