Provider Demographics
NPI:1497058648
Name:CHENTHILMURUGAN, HEMADEVI
Entity Type:Individual
Prefix:DR
First Name:HEMADEVI
Middle Name:
Last Name:CHENTHILMURUGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:HEMADEVI
Other - Middle Name:
Other - Last Name:SADASIVAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4001 E BASELINE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2743
Mailing Address - Country:US
Mailing Address - Phone:480-967-6888
Mailing Address - Fax:480-967-6887
Practice Address - Street 1:4001 E BASELINE RD STE 205
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2743
Practice Address - Country:US
Practice Address - Phone:480-967-6888
Practice Address - Fax:480-967-6887
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259105207L00000X
AZ49314207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035241Medicaid
NY259105OtherNY STATE LICENSE