Provider Demographics
NPI:1356333454
Name:CHALIKI, HEMASREE (MD)
Entity Type:Individual
Prefix:
First Name:HEMASREE
Middle Name:
Last Name:CHALIKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:1900 N. 2ND ST.
Practice Address - Street 2:STE. 121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-997-7331
Practice Address - Fax:602-870-4512
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531021Medicaid
AZH01835Medicare UPIN
AZ110229801Medicare PIN
AZ531021Medicaid
AZZ67420Medicare PIN
H01835Medicare UPIN