Healthcare Provider Details

I. General information

NPI: 1669423877
Provider Name (Legal Business Name): RANJIT ISAAC KYLATHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

12977 N VIA VISTA DEL PASADO
ORO VALLEY AZ
85755-5988
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5461
  • Fax: 520-324-1406
Mailing address:
  • Phone: 620-237-7656
  • Fax: 520-237-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number43699
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number39913
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number43192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: