Provider Demographics
NPI:1497758015
Name:COLATTUR, SHYAM NARAYANAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHYAM
Middle Name:NARAYANAN
Last Name:COLATTUR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2322
Mailing Address - Country:US
Mailing Address - Phone:602-997-0484
Mailing Address - Fax:602-224-3315
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:STE G790
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-843-7171
Practice Address - Fax:602-843-5909
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ28898207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ559198Medicaid
AZ117559Medicare PIN
AZ76414Medicare PIN
AZ117470Medicare PIN
AZ134863Medicare PIN
AZG86303Medicare UPIN
AZ559198Medicaid