Healthcare Provider Details

I. General information

NPI: 1740572403
Provider Name (Legal Business Name): ARTI THIAGARAJAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-1900
  • Fax:
Mailing address:
  • Phone: 602-933-1814
  • Fax: 727-346-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 120817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: