Provider Demographics
NPI:1679564512
Name:ZLAKET MATTA, GRACE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ZLAKET MATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9336 E RAINTREE DR
Mailing Address - Street 2:STE150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7322
Mailing Address - Country:US
Mailing Address - Phone:480-219-5597
Mailing Address - Fax:480-219-5547
Practice Address - Street 1:9336 E RAINTREE DR
Practice Address - Street 2:STE150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7322
Practice Address - Country:US
Practice Address - Phone:480-219-5597
Practice Address - Fax:480-219-5547
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ23480207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ326480Medicaid
AZ326480Medicaid
AZG17440Medicare UPIN