Provider Demographics
NPI:1265496665
Name:PREMKUMAR, ARCOT S (MD)
Entity Type:Individual
Prefix:
First Name:ARCOT
Middle Name:S
Last Name:PREMKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5090 N 40TH ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2111
Mailing Address - Country:US
Mailing Address - Phone:602-264-5685
Mailing Address - Fax:602-631-9870
Practice Address - Street 1:5090 N 40TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2111
Practice Address - Country:US
Practice Address - Phone:602-264-5685
Practice Address - Fax:602-631-9870
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ12870207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37472Medicare UPIN