Healthcare Provider Details

I. General information

NPI: 1962287748
Provider Name (Legal Business Name): HEMANT KUMAR KATTULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21250 W ROOSEVELT ST STE 108
BUCKEYE AZ
85326-0313
US

IV. Provider business mailing address

21250 W ROOSEVELT ST STE 108
BUCKEYE AZ
85326-0313
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9494
  • Fax: 623-935-9292
Mailing address:
  • Phone: 623-935-9494
  • Fax: 623-935-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: