Healthcare Provider Details

I. General information

NPI: 1568677706
Provider Name (Legal Business Name): GOBI KUMAR PARAMANANDAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 E SHEA BLVD STE 190
PHOENIX AZ
85028-4259
US

IV. Provider business mailing address

4611 E SHEA BLVD STE 190
PHOENIX AZ
85028-4259
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-0180
  • Fax: 480-889-0186
Mailing address:
  • Phone: 480-889-0180
  • Fax: 480-889-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number34996
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number34996
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: