Provider Demographics
NPI:1649248725
Name:ASOKAN, NATARAJAN (MD)
Entity type:Individual
Prefix:
First Name:NATARAJAN
Middle Name:
Last Name:ASOKAN
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 1:3931 STOCKTON HILL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2426
Mailing Address - Country:US
Mailing Address - Phone:928-681-5800
Mailing Address - Fax:928-681-5801
Practice Address - Street 1:3931 STOCKTON HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2426
Practice Address - Country:US
Practice Address - Phone:928-681-5800
Practice Address - Fax:928-681-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23270207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628925Medicare UPIN
64699Medicare ID - Type Unspecified