Healthcare Provider Details

I. General information

NPI: 1144372905
Provider Name (Legal Business Name): DESERT KIDNEY ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W BASELINE RD
MESA AZ
85210-6041
US

IV. Provider business mailing address

612 W BASELINE RD
MESA AZ
85210-6041
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-9039
  • Fax: 480-964-7802
Mailing address:
  • Phone: 480-834-9039
  • Fax: 480-964-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier526139
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: DHARMINDER S MARWAH
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 480-834-9039