Healthcare Provider Details

I. General information

NPI: 1558324640
Provider Name (Legal Business Name): RUPALI DREWEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUPALI BANSAL M.D.

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG 2108, SUITE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0985
  • Fax: 602-933-0323
Mailing address:
  • Phone: 602-512-8029
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15528R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49819
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number49819
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number37340
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: