Provider Demographics
NPI:1679501282
Name:ARIZONA HEMATOLOGY ONCOLOGY PC
Entity Type:Organization
Organization Name:ARIZONA HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KATAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-297-8429
Mailing Address - Street 1:PO BOX 36210
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6210
Mailing Address - Country:US
Mailing Address - Phone:520-297-8429
Mailing Address - Fax:520-297-2913
Practice Address - Street 1:6130 N LACHOLLA BLVD
Practice Address - Street 2:117
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-297-8429
Practice Address - Fax:520-297-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11471207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ215336Medicaid
AZ215336Medicaid