Healthcare Provider Details

I. General information

NPI: 1770746554
Provider Name (Legal Business Name): REECHA MADAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 N 5TH AVE STE 209
PHOENIX AZ
85013
US

IV. Provider business mailing address

3411 N 5TH AVE STE 209
PHOENIX AZ
85013-3812
US

V. Phone/Fax

Practice location:
  • Phone: 26-789-0344
  • Fax: 602-789-8389
Mailing address:
  • Phone: 26-789-0344
  • Fax: 602-789-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3193
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number55748
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: