Healthcare Provider Details

I. General information

NPI: 1245545474
Provider Name (Legal Business Name): ANUSHREE VARUN MONGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W. THUNDERBIRD BANNER THUNDERBIRD MEDICAL CENTER
GLENDALE AZ
85306
US

IV. Provider business mailing address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-2627
  • Fax: 602-865-2632
Mailing address:
  • Phone: 602-865-2627
  • Fax: 602-865-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50227
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: