Healthcare Provider Details

I. General information

NPI: 1417055708
Provider Name (Legal Business Name): PATTABI KALYANAM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 E BELL RD SUITE 115 BLDG 3
SCOTTSDALE AZ
85254-6007
US

IV. Provider business mailing address

5425 E BELL RD SUITE 115 BLDG 3
SCOTTSDALE AZ
85254-6007
US

V. Phone/Fax

Practice location:
  • Phone: 623-915-0270
  • Fax:
Mailing address:
  • Phone: 623-915-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27627
License Number StateAZ

VIII. Authorized Official

Name: PATTABI KALYANAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-915-0270