Healthcare Provider Details

I. General information

NPI: 1891180816
Provider Name (Legal Business Name): NARESH KUMAR DUGAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 02/09/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 N 90TH ST STE C120
SCOTTSDALE AZ
85258-5174
US

IV. Provider business mailing address

5550 E DEER VALLEY DR UNIT 333
PHOENIX AZ
85054-5669
US

V. Phone/Fax

Practice location:
  • Phone: 626-290-8091
  • Fax:
Mailing address:
  • Phone: 626-290-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2018017440
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number12-00444
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000978
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: