Healthcare Provider Details

I. General information

NPI: 1962613471
Provider Name (Legal Business Name): SAUDAMINI DEVENDRA WADWEKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE 130
GILBERT AZ
85297-1508
US

IV. Provider business mailing address

4100 S LINDSAY RD STE 130
GILBERT AZ
85297-1508
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-9531
  • Fax: 480-782-9530
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-296-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-R-7522
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: