Nurul Itqiyah Hariadi, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301090456 Issued in MI

Practice address

17900 N Porter Rd
Maricopa, AZ 85138-4228

Phone

(520) 233-2500

Fax

(520) 233-2574

NPI assigned

Nov 15, 2007

Last updated

Jul 22, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Banner Childrens Banner Health Clinic LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1407191216
  Medicare reassignment NPD
• Banner Childrens Banner Health Clinic LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1285278077
  NPD
• Banner Childrens Banner Health Clinic LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1558606020
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1881875037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17900 N PORTER RD",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851384228",
            "telephone_number": "520-233-2500",
            "fax_number": "520-233-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17900 N PORTER RD",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851384228",
            "telephone_number": "520-233-2500",
            "fax_number": "520-233-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARIADI",
        "first_name": "NURUL",
        "middle_name": "ITQIYAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301090456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Hadnot, LMT
• Andre Hall
• Julieanne Halley, LMSW
• Mahdi A Hammoud, R.PH
• Lauren Hampton
• Harmonia Counseling, LLC
• Harmony Haven Behavioral House
• Jamie Harpster
• Tijuana Harshaw
• Harshe Chiropractic LLC

• Pediatrics Physician in Maricopa, AZ
• Providers in Maricopa, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.