Organization · NPI-2

28th Street Medical Group, LLC

General Practice · Phoenix, AZ

NPI number1447723598

StatusActive

Last updated in NPPESJan 5, 2023

Details

NPI: 1447723598
Entity type: Organization (NPI-2)
Legal business name: 28th Street Medical Group, LLC
Organization subpart: No
Enumeration date: Jan 10, 2019
Certification date: Jan 5, 2023
Last updated: Jan 5, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208D00000X	General Practice	–	–	Yes
111N00000X	Chiropractor	–	–
208100000X	Physical Medicine & Rehabilitation	–	–
225100000X	Physical Therapist	–	–
363A00000X	Physician Assistant	–	–

Practice location

2836 E Indian School Rd Ste A8
Phoenix, AZ 85016-6864

Phone 602-840-0056 · Fax 480-926-2260

Mailing address

Po Box 6610
Chandler, AZ 85246-6610

Phone 480-926-7800 · Fax 480-926-2260

Authorized official

Radman Rahiminejad
Owner
4809267800

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