Provider Demographics
NPI:1184879082
Name:DEOKULE, SUNIL PRAKASH (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:PRAKASH
Last Name:DEOKULE
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 1:4800 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4701
Mailing Address - Country:US
Mailing Address - Phone:480-892-8400
Mailing Address - Fax:480-654-2868
Practice Address - Street 1:2149 W 24TH ST STE 1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6136
Practice Address - Country:US
Practice Address - Phone:928-726-4120
Practice Address - Fax:928-341-0315
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46840207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ785493Medicaid
AZ785493Medicaid