Provider Demographics
NPI:1427390194
Name:DILIP C DHADVAI MD PC
Entity Type:Organization
Organization Name:DILIP C DHADVAI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-457-7312
Mailing Address - Street 1:14506 W GRANITE VALLEY DR STE 217
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6013
Mailing Address - Country:US
Mailing Address - Phone:623-214-1809
Mailing Address - Fax:623-214-9018
Practice Address - Street 1:14506 W GRANITE VALLEY DR STE 217
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6013
Practice Address - Country:US
Practice Address - Phone:623-214-1809
Practice Address - Fax:623-214-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ02363261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty