Healthcare Provider Details

I. General information

NPI: 1457054314
Provider Name (Legal Business Name): JOSH CHERUKARA JOSEPH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PHILIP CHERUKARA JOSEPH

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD STE E-159
GLENDALE AZ
85306-4641
US

IV. Provider business mailing address

5301 SOUTH CONGRESS AVENUE 3 SOUTH
ATLANTIS FL
33462
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-8218
  • Fax:
Mailing address:
  • Phone: 561-548-1710
  • Fax: 561-548-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-001176
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: