Healthcare Provider Details

I. General information

NPI: 1669438552
Provider Name (Legal Business Name): PREM S PILLAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 W FRYE RD STE 5
CHANDLER AZ
85224-6238
US

IV. Provider business mailing address

1960 W FRYE RD STE 5
CHANDLER AZ
85224-6238
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-5900
  • Fax: 520-836-6663
Mailing address:
  • Phone: 480-917-5900
  • Fax: 520-836-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberM2754
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38206
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM2754
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMEDPHYSCOMLIC160330
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: