Provider Demographics
NPI:1992847651
Name:DAULAT, KUMAR PRAFUL (DO)
Entity Type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:PRAFUL
Last Name:DAULAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 E BELL RD STE 125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2238
Mailing Address - Country:US
Mailing Address - Phone:602-493-3677
Mailing Address - Fax:602-485-5156
Practice Address - Street 1:4045 E BELL RD STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2238
Practice Address - Country:US
Practice Address - Phone:602-493-3677
Practice Address - Fax:602-485-5156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ182874Medicaid
DO2635Medicare ID - Type Unspecified
AZ182874Medicaid