Healthcare Provider Details

I. General information

NPI: 1225254899
Provider Name (Legal Business Name): LAVANYA KODALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAVANYA YARLAGADDA MD

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5499
US

V. Phone/Fax

Practice location:
  • Phone: 480-301-8000
  • Fax:
Mailing address:
  • Phone: 480-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012027786
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number49902
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5179
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: