Provider Demographics
NPI:1285836395
Name:GOSALIA, KIRIT (MD)
Entity Type:Individual
Prefix:
First Name:KIRIT
Middle Name:
Last Name:GOSALIA
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 1:5620 W. THUNDERBIRD RD.
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-978-0154
Mailing Address - Fax:602-978-2797
Practice Address - Street 1:5620 W. THUNDERBIRD RD.
Practice Address - Street 2:SUITE E-1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-978-0154
Practice Address - Fax:602-978-2797
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11963207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ215295Medicaid
AZ215295Medicaid