Healthcare Provider Details

I. General information

NPI: 1265492060
Provider Name (Legal Business Name): SHIVA K RATUAPLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E CORONADO RD
PHOENIX AZ
85004-1525
US

IV. Provider business mailing address

3020 E CAMELBACK RD SUITE 301
PHOENIX AZ
85016-5059
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-5678
  • Fax: 602-264-5646
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: