1700812906 NPI number — KIRIT P GOSALIA MD PC

Table of content: (NPI 1700812906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700812906 NPI number — KIRIT P GOSALIA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRIT P GOSALIA MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700812906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5620 W THUNDERBIRD RD
Provider Second Line Business Mailing Address:
SUITE E1
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85306-4636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-978-0154
Provider Business Mailing Address Fax Number:
602-978-2797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5620 W THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
SUITE E1
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-978-0154
Provider Business Practice Location Address Fax Number:
602-978-2797
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOSALIA
Authorized Official First Name:
KIRIT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-978-0154

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  11963 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: WCFKQ . This is a "SUN HEALTH PHYSICIANS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 215295 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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