Provider Demographics
NPI:1366132318
Name:MOHAMED NIYAS, ABDULLAH (MD)
Entity type:Individual
Prefix:MR
First Name:ABDULLAH
Middle Name:
Last Name:MOHAMED NIYAS
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 1:400 N 32ND STREET
Mailing Address - Street 2:BUMCP INTERNAL MEDICINE CLINIC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:602-839-3927
Mailing Address - Fax:
Practice Address - Street 1:400 N 32ND STREET
Practice Address - Street 2:BUMCP INTERNAL MEDICINE CLINIC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-839-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-02-12
Deactivation Date:2023-12-18
Deactivation Code:
Reactivation Date:2024-02-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program