Provider Demographics
NPI:1821019944
Name:PARAMESHWARAN, SUBRAMANIAM (MD)
Entity Type:Individual
Prefix:
First Name:SUBRAMANIAM
Middle Name:
Last Name:PARAMESHWARAN
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:PO BOX 12185
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-2185
Mailing Address - Country:US
Mailing Address - Phone:520-426-9006
Mailing Address - Fax:520-836-4429
Practice Address - Street 1:1800 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5303
Practice Address - Country:US
Practice Address - Phone:520-426-9006
Practice Address - Fax:520-836-4429
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ911819Medicaid
AZ911819Medicaid
AZZ101477Medicare PIN