DR. ASAD EHTISHAM (NPI# 1558366856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558366856 |
| Entity Type | Individual |
| Full Name | DR. ASAD EHTISHAM |
| Credential | MD |
| Practice Address |
15396 N 83rd Ave Ste E Peoria AZ 85381-5627 |
| Mailing Address |
Po Box 43108 Phoenix AZ 85080-3108 |
| Practice Telephone | 6233003684 |
| Mailing Telephone | 6026630993 |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-08-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
48099 | AZ | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
37736 | KY | Allopathic & Osteopathic Physicians |
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
37736 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | SIHO - NNS | 109615 | 01 |
| KS | 200329930A | 05 | |
| KY | ANTHEM - NNS | 000000639847 | 01 |
| KY | HUMANA - NNS | 000052152Q | 01 |
| IN | 200972890 | 05 | |
| KY | AETNA - NNS | 7601540 | 01 |
| KY | PASSPORT & PASSPORT ADV - NNS | 50028054 | 01 |
| KY | CIGNA - NNS | 5128838 | 01 |
| KY | 7100096130 | 05 |
| Street Address |
15396 N 83RD AVE STE E |
| City | PEORIA |
| State | AZ |
| Zip Code | 85381-5627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467067892 | Alyssa Angulo Lopez | Nurse Practitioner | 15396 N 83rd Ave Ste E, Peoria, AZ 85381-5627 | 2020-09-11 |
| 1396145264 | Envi Pllc | Psychiatry & Neurology | 15396 N 83rd Ave Ste E, Peoria, AZ 85381-5627 | 2014-08-28 |
| 1689014557 | Jkl Professional Counseling Services | Counselor | 15396 N 83rd Ave Ste E, Peoria, AZ 85381-5627 | 2013-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932712122 | Vicki L Grenier | Registered Nurse | 7558 W. Thunderbird Rd. Ste 1-507, Peoria, AZ 85381 | 2020-08-26 |
| 1568934107 | Earthwalk Wellness Group, LLC | Social Worker | 14050 North 83rd Avenue, Suite 290, Peoria, AZ 85381 | 2018-12-20 |
| 1316412059 | John & Biljana Feeley Dba J & B Assisted Living IIi Inc | Community Based Residential Treatment Facility, Mental Illness | 7331 W Sweetwater Avenue, Peoria, AZ 85381 | 2018-10-09 |
| 1467958611 | Arizona Community Pharmacy | Pharmacy | 14100 N 83rd Ave Ste 160, Peoria, AZ 85381 | 2018-04-04 |
| 1083112106 | Marissa Lynn Desjardins | Physical Therapist | 8240 W. Cactus Rd. Oakeson Physical Therapy, Peoria, AZ 85381 | 2018-01-23 |
| 1235651399 | Power Back Batteries LLC | Durable Medical Equipment & Medical Supplies | 9054 West Lisbon Ave, Peoria, AZ 85381 | 2017-07-11 |
| 1457897027 | Sonoran Sky Community Services | Community Based Residential Treatment Facility, Mental Illness | 7524 W. Alexandria Way, Peoria, AZ 85381 | 2017-01-06 |
| 1386023448 | Scott Boone | Registered Nurse | 7715 W Watson Ln, Peoria, AZ 85381 | 2015-05-22 |
| 1881084838 | Pinnacle Women's Center LLC | Obstetrics & Gynecology | 15396 N 83rd Ave Ste F100, Peoria, AZ 85381 | 2015-01-29 |
| 1245637081 | Kathi Locke | Counselor | 13460 N. 94th Drive, Suite J2, Peoria, AZ 85381 | 2014-11-21 |
| Find all providers in zip 85381 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| 1881815488 | Jacob Tony | Psychiatry & Neurology | 900 Main St Ste 250, Peoria, IL 61602-5006 | 2007-05-01 |
| 1861473076 | Dennis Q Mcmanus | Psychiatry & Neurology | 8600 N Il-91, Suite 110, Peoria, IL 61615 | 2005-11-07 |
| 1073503819 | Robert I(sa) Pfeffer | Psychiatry & Neurology | 3323 W Gloucester Ct, Peoria, IL 61615-2601 | 2005-10-24 |
| 1700375854 | Maxwell Quincy Nyce | Psychiatry & Neurology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2018-05-03 |
| 1396145264 | Envi Pllc | Psychiatry & Neurology | 15396 N 83rd Ave Ste E, Peoria, AZ 85381-5627 | 2014-08-28 |
| 1134535693 | Elias Samaha | Psychiatry & Neurology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2014-07-05 |
| 1831504844 | Javad Alam | Psychiatry & Neurology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2014-06-27 |
| 1285047977 | Deepak Reddy | Psychiatry & Neurology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2014-06-10 |
| 1023436995 | Douglas Juvinall | Psychiatry & Neurology | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2014-03-28 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.