Provider Demographics
NPI:1649239013
Name:SHAM M VENGURLEKAR, MD, PC
Entity Type:Organization
Organization Name:SHAM M VENGURLEKAR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:VENGURLEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-314-2288
Mailing Address - Street 1:7010 E CHAUNCEY LN
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3111
Mailing Address - Country:US
Mailing Address - Phone:480-314-2288
Mailing Address - Fax:480-314-1113
Practice Address - Street 1:7010 E CHAUNCEY LN
Practice Address - Street 2:SUITE 215
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3117
Practice Address - Country:US
Practice Address - Phone:480-314-2288
Practice Address - Fax:480-314-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ68313Medicare PIN
AZE18660Medicare UPIN