Provider Demographics
NPI:1467567883
Name:DAULAT, RAJESH PRAFUL (DPM)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:PRAFUL
Last Name:DAULAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:J171/ J172
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-977-6245
Mailing Address - Fax:623-977-6280
Practice Address - Street 1:6677 W THUNDERBIRD RD STE J171-172
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3732
Practice Address - Country:US
Practice Address - Phone:623-977-6245
Practice Address - Fax:623-977-6280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0547213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ577380Medicaid
AZAZ0194990OtherBCBS
AZU85535Medicare UPIN
AZ577380Medicaid
AZZ77224Medicare PIN