Provider Demographics
NPI:1790973006
Name:NEENA K UPPAL MD PC
Entity Type:Organization
Organization Name:NEENA K UPPAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-544-6860
Mailing Address - Street 1:14674 W MOUNTAIN VIEW BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2708
Mailing Address - Country:US
Mailing Address - Phone:623-544-6860
Mailing Address - Fax:623-544-6861
Practice Address - Street 1:14674 W MOUNTAIN VIEW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-544-6860
Practice Address - Fax:623-544-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ423533Medicaid
AZ423533Medicaid