Provider Demographics
NPI:1982661799
Name:RATHOD, MAYUR A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:A
Last Name:RATHOD
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 829
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-0829
Mailing Address - Country:US
Mailing Address - Phone:480-455-3000
Mailing Address - Fax:866-681-9061
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR STE 125
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4583
Practice Address - Country:US
Practice Address - Phone:480-455-3000
Practice Address - Fax:866-819-6115
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947062-01Medicaid
AZ947062-01Medicaid
AZZ104030Medicare PIN