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General NPI Number Information
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NPI Number | 1649456229
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Entity Type | Organization
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Legal Business Name | MARICOPA PODIATRY CORPORATION
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 12361 W BOLA DR SUITE 100
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City | SURPRISE
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State | AZ
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Zip | 85378-9021
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Country | US
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Telephone | 623-214-3335
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Fax | 623-214-3956
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Provider Business Mailing Address
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Address Line | PO BOX 9350
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City | SURPRISE
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State | AZ
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Zip | 85374-0139
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Country | US
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Telephone | 623-214-3335
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Fax | 623-214-3956
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Authorized Official
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Title or Position | OWNER
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Name | DR. THARESH UDUPA
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Credential | DPM
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Telephone | 623-214-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0599
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License Number State | AZ
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