Healthcare Provider Details

I. General information

NPI: 1255398194
Provider Name (Legal Business Name): ROHIT DWIVEDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12361 W BOLA DR STE 109
SURPRISE AZ
85378-9021
US

IV. Provider business mailing address

12361 W BOLA DR STE 109
SURPRISE AZ
85378-9021
US

V. Phone/Fax

Practice location:
  • Phone: 623-227-1000
  • Fax: 623-227-2000
Mailing address:
  • Phone: 623-227-1000
  • Fax: 623-227-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number30335
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number30335
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: