=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427390194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DILIP C DHADVAI MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2013
-----------------------------------------------------
Last Update Date | 03/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14506 W GRANITE VALLEY DR STE 217
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-214-1809
-----------------------------------------------------
Fax | 623-214-9018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14506 W GRANITE VALLEY DR STE 217
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-214-1809
-----------------------------------------------------
Fax | 623-214-9018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MR. SHAUN KANAKA
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 602-457-7312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | AZ02363
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------