Healthcare Provider Details

I. General information

NPI: 1689293862
Provider Name (Legal Business Name): TUSHAR MENON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 W MCDOWELL RD STE 101
GOODYEAR AZ
85395-2625
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-4700
  • Fax: 623-935-4707
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71044
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: