Provider Demographics
NPI:1013065770
Name:KURLI, MADHAVI (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:KURLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19820 N 7TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1689
Mailing Address - Country:US
Mailing Address - Phone:480-397-9560
Mailing Address - Fax:480-397-9561
Practice Address - Street 1:19820 N 7TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1689
Practice Address - Country:US
Practice Address - Phone:480-397-9560
Practice Address - Fax:480-397-9561
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252324207W00000X
AZ44792207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ632949Medicaid