Healthcare Provider Details

I. General information

NPI: 1356412977
Provider Name (Legal Business Name): KUSUM L BHATHEJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 N 3RD AVE # 100
PHOENIX AZ
85013-4360
US

IV. Provider business mailing address

13236 N 7TH ST #4-290
PHOENIX AZ
85022-5343
US

V. Phone/Fax

Practice location:
  • Phone: 602-914-1520
  • Fax:
Mailing address:
  • Phone: 602-705-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10425
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: