Provider Demographics
NPI:1669423877
Name:KYLATHU, RANJIT ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:RANJIT
Middle Name:ISAAC
Last Name:KYLATHU
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 1:12977 N VIA VISTA DEL PASADO
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-5988
Mailing Address - Country:US
Mailing Address - Phone:620-237-7656
Mailing Address - Fax:520-237-7656
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-324-5461
Practice Address - Fax:520-324-1406
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK436992080N0001X
TN399132080N0001X
AZ431922080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I45966Medicare UPIN