Healthcare Provider Details

I. General information

NPI: 1730983412
Provider Name (Legal Business Name): GLENDALE INFECTIOUS DISEASES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 W THUNDERBIRD RD STE 201
GLENDALE AZ
85306-4722
US

IV. Provider business mailing address

5310 W THUNDERBIRD RD STE 201
GLENDALE AZ
85306-4722
US

V. Phone/Fax

Practice location:
  • Phone: 623-335-4110
  • Fax: 623-335-4130
Mailing address:
  • Phone: 623-335-4110
  • Fax: 623-335-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MANDEEP KAUR RAI
Title or Position: MD/OWNER
Credential: MD
Phone: 623-335-4110