Healthcare Provider Details

I. General information

NPI: 1720766025
Provider Name (Legal Business Name): KARTHIK RAYASAM MBBS ,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1625 N. CAMPBELL AVE DEPARTMENT OF RADIOLOGY & IMAGING SCIENCES
TUCSON AZ
85719
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-0111
  • Fax:
Mailing address:
  • Phone: 520-694-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberR80219
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberR80219
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberR80219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: