Healthcare Provider Details

I. General information

NPI: 1255384103
Provider Name (Legal Business Name): KUDAGAL S MURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 E GRANT RD
TUCSON AZ
85716-2742
US

IV. Provider business mailing address

2902 E GRANT RD
TUCSON AZ
85716-2742
US

V. Phone/Fax

Practice location:
  • Phone: 520-322-8361
  • Fax: 520-322-8462
Mailing address:
  • Phone: 520-322-8361
  • Fax: 520-322-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number13339
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: