Organization
PRESCOTT INTERVENTIONAL RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED A KIRDANI M.D. (PRESIDENT OWNER)
(928) 443-0077
Entity
Organization
Contact information
Practice address
980 WILLOW CREEK RD, PRESCOTT, AZ 86301-1611
(928) 443-0077
(928) 443-0019
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z7128
HEALTH NET
—
Enumeration date
04/07/2006
Last updated
09/11/2025
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