Healthcare Provider Details

I. General information

NPI: 1700874153
Provider Name (Legal Business Name): GARGI M DWIVEDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 E CAMELBACK RD STE D155
PHOENIX AZ
85018-2888
US

IV. Provider business mailing address

PO BOX 88747
MILWAUKEE WI
53288-8747
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-2444
  • Fax:
Mailing address:
  • Phone: 480-626-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33472
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: