Provider Demographics
NPI:1629270731
Name:JANA, DIPAK (MD)
Entity Type:Individual
Prefix:
First Name:DIPAK
Middle Name:
Last Name:JANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN STE 150A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:602-584-5444
Mailing Address - Fax:602-584-6202
Practice Address - Street 1:269 S CANDY LN
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4158
Practice Address - Country:US
Practice Address - Phone:928-634-1331
Practice Address - Fax:928-634-3130
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ13578207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ251091Medicaid
AZZ234185OtherMEDICARE
AZ251091Medicaid