Provider Demographics
NPI:1649313917
Name:ALLERGY & ASTHMA CARE OF ARIZONA
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CARE OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KUDAGAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-608-7201
Mailing Address - Street 1:PO BOX 25038
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-609-7201
Mailing Address - Fax:480-502-0140
Practice Address - Street 1:2451 S AVENUE A
Practice Address - Street 2:SUITE 22
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-2300
Practice Address - Fax:928-426-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ68153Medicare PIN