Provider Demographics
NPI:1073629515
Name:KHERA CARDIOLOGY CENTER PC
Entity Type:Organization
Organization Name:KHERA CARDIOLOGY CENTER PC
Other - Org Name:KHERA CARDIOLOGY CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-987-6111
Mailing Address - Street 1:5620 W THUNDERBIRD RD STE E4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4651
Mailing Address - Country:US
Mailing Address - Phone:602-296-7224
Mailing Address - Fax:602-535-5284
Practice Address - Street 1:5620 W THUNDERBIRD RD STE E4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4651
Practice Address - Country:US
Practice Address - Phone:602-296-7224
Practice Address - Fax:602-535-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77609Medicare ID - Type UnspecifiedMEDICARE