Provider Demographics
NPI:1417056730
Name:MULEY, SURAJ ASHOK (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAJ
Middle Name:ASHOK
Last Name:MULEY
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:FILE 56765
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-6765
Mailing Address - Country:US
Mailing Address - Phone:602-406-3860
Mailing Address - Fax:602-406-6132
Practice Address - Street 1:240 W THOMAS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4407
Practice Address - Country:US
Practice Address - Phone:602-406-6262
Practice Address - Fax:602-406-4606
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ419642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027885OtherPREFERREDONE
05-00156OtherMEDICA CHOICE
160790OtherUCARE
WI34048400Medicaid
05-00009OtherMEDICA PRIMARY
MN070A2MUOtherBLUECROSS BLUESHIELD
HP33188OtherHEALTHPARTNERS
1245756OtherARAZ
MN702603000Medicaid
IA0536235Medicaid
MN702603000Medicaid
1245756OtherARAZ
130000977Medicare ID - Type UnspecifiedMEDICARE