Healthcare Provider Details

I. General information

NPI: 1073629515
Provider Name (Legal Business Name): KHERA CARDIOLOGY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD STE E4
GLENDALE AZ
85306-4651
US

IV. Provider business mailing address

5620 W THUNDERBIRD RD STE E4
GLENDALE AZ
85306-4651
US

V. Phone/Fax

Practice location:
  • Phone: 602-296-7224
  • Fax: 602-535-5284
Mailing address:
  • Phone: 602-296-7224
  • Fax: 602-535-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20871
License Number StateAZ

VIII. Authorized Official

Name: DR. GORDI KHERA
Title or Position: OWNER
Credential: MD
Phone: 602-987-6111