MEDICARE: RAJ MAKADIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	51596	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386086569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJ MAKADIA MD

Provider Business Mailing Address
First Line	:	2929 E THOMAS RD
Second Line	:	FAMILY MEDICINE
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8034
Country	:	US
Telephone Number	:	602-470-5043
Fax Number	:	602-470-5064

Provider Business Practice Location Address
First Line	:	12428 W THUNDERBIRD RD
Second Line	:	FAMILY MEDICINE
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-3113
Country	:	US
Telephone Number	:	623-344-6500
Fax Number	:	623-344-6501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	07/12/2016

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