MEDICARE: RADHA A RAMAMRUTHAM 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	27554	AZ

General Provider Information

NPI Number	:	1508839937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADHA A RAMAMRUTHAM MD

Provider Business Mailing Address
First Line	:	1707 W BLUE SKY DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-5333
Country	:	US
Telephone Number	:	623-434-0152
Fax Number	:	623-583-1099

Provider Business Practice Location Address
First Line	:	20325 N 51ST AVE BLDG 6
Second Line	:	SUITE 142
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5674
Country	:	US
Telephone Number	:	623-587-4500
Fax Number	:	623-587-4681

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/06/2024

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