Healthcare Provider Details

I. General information

NPI: 1609929538
Provider Name (Legal Business Name): MADHAVI MEKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD BUILDING 8, SUITE 208
PHOENIX AZ
85032-9393
US

IV. Provider business mailing address

2315 E HATCHER RD
PHOENIX AZ
85028-4600
US

V. Phone/Fax

Practice location:
  • Phone: 817-684-2700
  • Fax: 817-684-2709
Mailing address:
  • Phone: 912-441-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number001738
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberP1106
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number46854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: