Provider Demographics
NPI:1386673416
Name:RISHI, RADHA GANDHI (MD)
Entity Type:Individual
Prefix:
First Name:RADHA
Middle Name:GANDHI
Last Name:RISHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RADHA
Other - Middle Name:KANAIYALAL
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:705 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5657
Mailing Address - Country:US
Mailing Address - Phone:480-897-6992
Mailing Address - Fax:480-752-1757
Practice Address - Street 1:705 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5657
Practice Address - Country:US
Practice Address - Phone:480-897-6992
Practice Address - Fax:480-839-1874
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35368174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126269Medicaid
115115Medicare PIN
I73218Medicare UPIN