Healthcare Provider Details

I. General information

NPI: 1679501282
Provider Name (Legal Business Name): ARIZONA HEMATOLOGY ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 N LACHOLLA BLVD 117
TUCSON AZ
85741
US

IV. Provider business mailing address

PO BOX 36210
TUCSON AZ
85740-6210
US

V. Phone/Fax

Practice location:
  • Phone: 520-297-8429
  • Fax: 520-297-2913
Mailing address:
  • Phone: 520-297-8429
  • Fax: 520-297-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number11471
License Number StateAZ

VIII. Authorized Official

Name: DR. SURESH B KATAKKAR
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 520-297-8429