Provider Demographics
NPI:1063850709
Name:AGRAWAL, YASHWANT (MD)
Entity Type:Individual
Prefix:
First Name:YASHWANT
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 W FRYE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6238
Mailing Address - Country:US
Mailing Address - Phone:480-917-5900
Mailing Address - Fax:520-836-6661
Practice Address - Street 1:1960 W FRYE RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6238
Practice Address - Country:US
Practice Address - Phone:480-917-5900
Practice Address - Fax:520-836-6663
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62297207RC0000X, 207RI0011X
MI4301103090390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program