Healthcare Provider Details

I. General information

NPI: 1124022819
Provider Name (Legal Business Name): KRISHNA M PINNAMANENI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 E SOUTHERN AVE STE 1
TEMPE AZ
85282-5881
US

IV. Provider business mailing address

1847 E SOUTHERN AVE STE 1
TEMPE AZ
85282-5881
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-2277
  • Fax: 480-838-3887
Mailing address:
  • Phone: 480-838-2277
  • Fax: 480-838-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number14173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: