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1174584601

NPI Code Detail

MEDICARE: DR. RAGHU V DEVABHAKTUNI MD

MEDICARE: DR. RAGHU V DEVABHAKTUNI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0061245	FL
2	2084P0805X	Geriatric Psychiatry Physician	ME 0061245	FL
3	2084P0805X	Geriatric Psychiatry Physician	58835	AZ
4	2084P0800X	Psychiatry Physician	58835	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	260046846	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174584601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHU V DEVABHAKTUNI MD

Provider Business Mailing Address
First Line	:	2929 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8034
Country	:	US
Telephone Number	:	602-470-5000
Fax Number	:	602-470-5064

Provider Business Practice Location Address
First Line	:	5102 W CAMPBELL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1703
Country	:	US
Telephone Number	:	602-344-5011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2006
Last Update Date	:	05/14/2021

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Directions to “ DR. RAGHU V DEVABHAKTUNI MD” Practice Location

Language	Start Address	Practice Location

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