Healthcare Provider Details

I. General information

NPI: 1144457961
Provider Name (Legal Business Name): ANKUR JANAK SHUKLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N PLAZA DEL RIO BLVD STE 240
PEORIA AZ
85381-4846
US

IV. Provider business mailing address

13640 N PLAZA DEL RIO BLVD STE 240
PEORIA AZ
85381-4846
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-0868
  • Fax: 602-457-8319
Mailing address:
  • Phone: 602-462-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number64208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: