Healthcare Provider Details

I. General information

NPI: 1609893502
Provider Name (Legal Business Name): ARUN K. KOLLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 E BAYWOOD AVE # 301
MESA AZ
85206-1749
US

IV. Provider business mailing address

6402 E SUPERSTITION SPRINGS BLVD STE 224
MESA AZ
85206-4394
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-6100
  • Fax: 480-505-5287
Mailing address:
  • Phone: 480-835-6100
  • Fax: 480-505-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number36429
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36429
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: