Provider Demographics
NPI:1013984970
Name:SREECHARANA, THIMMAVAJJHALA (MD)
Entity Type:Individual
Prefix:DR
First Name:THIMMAVAJJHALA
Middle Name:
Last Name:SREECHARANA
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 5336
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5336
Mailing Address - Country:US
Mailing Address - Phone:623-933-2732
Mailing Address - Fax:623-972-1323
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4828
Practice Address - Country:US
Practice Address - Phone:623-933-2732
Practice Address - Fax:623-972-1323
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19302207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171182Medicaid
AZE86245Medicare UPIN
AZ171182Medicaid