Provider Demographics
NPI:1578517793
Name:G & K MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:G & K MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:BHUSHAN
Authorized Official - Last Name:GALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-935-1000
Mailing Address - Street 1:10450 W MCDOWELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4802
Mailing Address - Country:US
Mailing Address - Phone:623-935-1000
Mailing Address - Fax:623-935-1022
Practice Address - Street 1:10450 W MCDOWELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4802
Practice Address - Country:US
Practice Address - Phone:623-935-1000
Practice Address - Fax:623-935-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ882812Medicaid
AZ=========OtherTAX ID
AZ882812Medicaid