Provider Demographics
NPI:1629025796
Name:NAIR, VASUDEVAN KG (MD)
Entity Type:Individual
Prefix:
First Name:VASUDEVAN
Middle Name:KG
Last Name:NAIR
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 1:2149 E WARNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:866-301-2151
Practice Address - Street 1:301 S POWER RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5243
Practice Address - Country:US
Practice Address - Phone:480-325-7535
Practice Address - Fax:480-325-7462
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35514207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147325OtherBANNER MD ANDERSON CANCER CENTER
AZ149727Medicaid
AZZ147325OtherBANNER MD ANDERSON CANCER CENTER