Healthcare Provider Details

I. General information

NPI: 1295077675
Provider Name (Legal Business Name): EKTA BAJAJ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 W MCDOWELL RD
AVONDALE AZ
85392-5960
US

IV. Provider business mailing address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 623-873-0321
  • Fax: 623-849-9623
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52865
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: