Provider Demographics
NPI:1669432530
Name:BHARARA, SURINDER (MD)
Entity type:Individual
Prefix:
First Name:SURINDER
Middle Name:
Last Name:BHARARA
Suffix:
Gender:F
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:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:655 S DOBSON RD STE B113
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-728-5020
Practice Address - Fax:480-899-5023
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ980806Medicaid
Z130591Medicare PIN
AZI47571Medicare UPIN
AZ107125Medicare ID - Type UnspecifiedMEDICARE NUMBER
I47571Medicare UPIN
AZ980806Medicaid