MEDICARE: DR. SHYAM NARAYANAN COLATTUR M.D.

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	207RN0300X	Nephrology Physician	28898	AZ

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	:	1497758015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHYAM NARAYANAN COLATTUR M.D.

Provider Business Mailing Address
First Line	:	3333 E CAMELBACK RD
Second Line	:	SUITE 180
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2322
Country	:	US
Telephone Number	:	602-997-0484
Fax Number	:	602-224-3315

Provider Business Practice Location Address
First Line	:	5750 W THUNDERBIRD RD
Second Line	:	STE G790
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4660
Country	:	US
Telephone Number	:	602-843-7171
Fax Number	:	602-843-5909

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/21/2022

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