Provider Demographics
NPI:1568452357
Name:KAUR, SIMRAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMRAT
Middle Name:
Last Name:KAUR
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 1:2500 W UTOPIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-485-7434
Practice Address - Fax:602-485-7440
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101206559Medicaid
PA101206559Medicaid
PAH82815Medicare UPIN