Provider Demographics
NPI:1265443782
Name:KUMARI AGARWAL, REKHA (MD)
Entity Type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:KUMARI AGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REKHA
Other - Middle Name:
Other - Last Name:KUMARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-876-6909
Practice Address - Street 1:9165 W THUNDERBIRD RD
Practice Address - Street 2:STE 200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4847
Practice Address - Country:US
Practice Address - Phone:623-876-6960
Practice Address - Fax:623-876-6909
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14709R207RE0101X
AZ37249207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117056Medicare PIN
AZZ117055Medicare PIN
AZH74070Medicare UPIN