Provider Demographics
NPI:1619971306
Name:PINNAMANENI, BHAVANI K (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANI
Middle Name:K
Last Name:PINNAMANENI
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 1:1847 E SOUTHERN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5881
Mailing Address - Country:US
Mailing Address - Phone:480-838-2277
Mailing Address - Fax:480-838-3887
Practice Address - Street 1:1847 E SOUTHERN AVE
Practice Address - Street 2:STE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5881
Practice Address - Country:US
Practice Address - Phone:480-838-2277
Practice Address - Fax:480-838-3887
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AZ14172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics