Provider Demographics
NPI:1679602833
Name:SAROJ N KULKARNI MD PC
Entity Type:Organization
Organization Name:SAROJ N KULKARNI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAROJ
Authorized Official - Middle Name:N
Authorized Official - Last Name:KULKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-214-4569
Mailing Address - Street 1:4331 E BASELINE RD
Mailing Address - Street 2:SUITE B 105-177
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2961
Mailing Address - Country:US
Mailing Address - Phone:602-214-4569
Mailing Address - Fax:480-633-3524
Practice Address - Street 1:4331 E BASELINE RD
Practice Address - Street 2:SUITE B 105-177
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2961
Practice Address - Country:US
Practice Address - Phone:602-214-4569
Practice Address - Fax:480-633-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ357302Medicaid
AZ114749Medicare PIN