Provider Demographics
NPI:1184607004
Name:AGARWAL, SUDHIR P (MD)
Entity type:Individual
Prefix:
First Name:SUDHIR
Middle Name:P
Last Name:AGARWAL
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 1:5757 W THUNDERBIRD ROAD
Mailing Address - Street 2:SUITE W301
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4641
Mailing Address - Country:US
Mailing Address - Phone:602-938-3777
Mailing Address - Fax:602-547-0379
Practice Address - Street 1:5757 W THUNDERBIRD ROAD
Practice Address - Street 2:SUITE W301
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-938-3777
Practice Address - Fax:602-547-0379
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17587207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D36484Medicare UPIN