Provider Demographics
NPI:1366546665
Name:QASIMYAR, AHMAD ZAKY (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:ZAKY
Last Name:QASIMYAR
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 1:5048 W. NORTHERN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1548
Mailing Address - Country:US
Mailing Address - Phone:623-435-0190
Mailing Address - Fax:623-435-0193
Practice Address - Street 1:5048 W NORTHERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1558
Practice Address - Country:US
Practice Address - Phone:623-435-0190
Practice Address - Fax:623-435-0193
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236183207Q00000X
AZ41474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ441696Medicaid
005855M36Medicare ID - Type Unspecified
I21143Medicare UPIN