Provider Demographics
NPI:1629268503
Name:SUBBIAH, YAMINI (MD)
Entity Type:Individual
Prefix:
First Name:YAMINI
Middle Name:
Last Name:SUBBIAH
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:
Practice Address - Street 1:19646 N 27TH AVE
Practice Address - Street 2:SUITE 301 DR. SUBBIAH-GASTROENTEROLOGY (CARE FOR WOMEN)
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4017
Practice Address - Country:US
Practice Address - Phone:623-780-5528
Practice Address - Fax:623-780-5529
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432305207R00000X
AZ46889207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ771866Medicaid
PA1020082610001Medicaid
AZZ92919Medicare PIN
PA1020082610001Medicaid