Provider Demographics
NPI:1619147915
Name:CHADHA, KRISHDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHDEEP
Middle Name:
Last Name:CHADHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:SUITE 478
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3328
Mailing Address - Country:US
Mailing Address - Phone:623-236-8507
Mailing Address - Fax:623-236-8508
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 478
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-236-8507
Practice Address - Fax:623-236-8508
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247585207R00000X
AZ42491207RG0100X
CAA129186207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ509316Medicaid