Provider Demographics
NPI:1174504534
Name:WADWEKAR, DEVENDRA G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVENDRA
Middle Name:G
Last Name:WADWEKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 S LINDSAY RD
Mailing Address - Street 2:STE 130
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1506
Mailing Address - Country:US
Mailing Address - Phone:480-782-9531
Mailing Address - Fax:480-782-9530
Practice Address - Street 1:4100 S LINDSAY RD
Practice Address - Street 2:STE 130
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1506
Practice Address - Country:US
Practice Address - Phone:480-782-9531
Practice Address - Fax:480-782-9530
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ44679207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0290775Medicaid
IAH82367Medicare UPIN
IAI16772Medicare ID - Type Unspecified
Z147300Medicare PIN
IAI9401Medicare ID - Type Unspecified