Provider Demographics
NPI:1295743177
Name:SWAROOP, PRABHAKAR (MD)
Entity type:Individual
Prefix:
First Name:PRABHAKAR
Middle Name:
Last Name:SWAROOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRABHAKAR
Other - Middle Name:
Other - Last Name:SWAROOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5111 N SCOTTSDALE RD STE 151
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7004
Mailing Address - Country:US
Mailing Address - Phone:602-254-6686
Mailing Address - Fax:602-254-4258
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 151
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7004
Practice Address - Country:US
Practice Address - Phone:602-254-6686
Practice Address - Fax:602-254-4258
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55206207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ231883OtherPTAN
AZ479779Medicaid