Provider Demographics
NPI: | 1477841914 |
---|---|
Name: | SINGARAVELU, KUMARA (MD, MPH) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KUMARA |
Middle Name: | |
Last Name: | SINGARAVELU |
Suffix: | |
Gender: | M |
Credentials: | MD, MPH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2510 W DUNLAP AVE |
Mailing Address - Street 2: | SUITE 290 |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85021-2737 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-789-0344 |
Mailing Address - Fax: | 602-789-8389 |
Practice Address - Street 1: | 2510 W DUNLAP AVE |
Practice Address - Street 2: | SUITE 290 |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85021-2737 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-789-0344 |
Practice Address - Fax: | 602-789-8389 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-07-19 |
Last Update Date: | 2016-12-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 47109 | 207RI0200X, 207R00000X, 207RI0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 811443 | Medicaid | |
AZ | Z158608 | Medicare PIN |