Provider Demographics
NPI:1437143872
Name:PADDA, SUKHDEEP S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUKHDEEP
Middle Name:S
Last Name:PADDA
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 1:20100 N 51ST AVE
Mailing Address - Street 2:SUITE F620
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:623-376-6328
Mailing Address - Fax:622-566-6454
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE F620
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:623-376-6328
Practice Address - Fax:622-566-6454
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27340207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ495912Medicaid
AZ1Z5729OtherHEALTHNET
AZAZ0702450OtherBCBS
AZ495912Medicaid
AZ73372Medicare ID - Type Unspecified
AZAZ0702450OtherBCBS