Provider Demographics
NPI:1659535102
Name:SHANMUGAM, NATARAJ (MD)
Entity Type:Individual
Prefix:
First Name:NATARAJ
Middle Name:
Last Name:SHANMUGAM
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 1:3400 DATA DR
Mailing Address - Street 2:RADIOLOGY, 2ND FLOOR/ADMIN
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-363-3317
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST FL 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3301
Practice Address - Fax:916-281-3882
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115371207U00000X, 2085R0202X
AZ428692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA115371OtherMEDICAL LICENSE
AZZ137927OtherMEDICARE PTAN FOR MDIG-YUMA
AZ524526Medicaid