Provider Demographics
NPI:1902184112
Name:TAKYAR, PLLC.
Entity Type:Organization
Organization Name:TAKYAR, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAKYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-749-3031
Mailing Address - Street 1:5216 N SABINO HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-7120
Mailing Address - Country:US
Mailing Address - Phone:520-749-3031
Mailing Address - Fax:240-252-5668
Practice Address - Street 1:1702 W ANKLAM RD
Practice Address - Street 2:SUITE 111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2606
Practice Address - Country:US
Practice Address - Phone:520-749-3031
Practice Address - Fax:240-252-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ507437Medicaid