Provider Demographics
NPI:1508826413
Name:JANGA, RADHIKA (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:JANGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 S POWER RD
Mailing Address - Street 2:STE 120
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3624
Mailing Address - Country:US
Mailing Address - Phone:480-813-6699
Mailing Address - Fax:480-813-6697
Practice Address - Street 1:4135 S POWER RD
Practice Address - Street 2:STE 120
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3624
Practice Address - Country:US
Practice Address - Phone:480-813-6699
Practice Address - Fax:480-813-6697
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ890302Medicaid
AZ890302Medicaid
AZZ106809Medicare ID - Type Unspecified