Provider Demographics
NPI:1376598151
Name:VIJAYARAGHAVAN, KRISHNASWAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNASWAMI
Middle Name:
Last Name:VIJAYARAGHAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:VIJAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3099 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6903
Mailing Address - Country:US
Mailing Address - Phone:480-945-3535
Mailing Address - Fax:480-994-8179
Practice Address - Street 1:3099 N CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6903
Practice Address - Country:US
Practice Address - Phone:480-945-3535
Practice Address - Fax:480-994-8179
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z2051OtherHEALTHNET
AZP00187973OtherRAILROAD MEDICARE
AZ1929999OtherUNITEDHEALTHCARE
AZ2441047OtherCIGNA
AZ7721013OtherAETNA
AZAZ0769180OtherBCBS AZ
AZ1929999OtherUNITEDHEALTHCARE
AZ2441047OtherCIGNA