Provider Demographics
NPI:1720079510
Name:MOHAN, RUPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUPAL
Middle Name:
Last Name:MOHAN
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 1:16872 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2506
Mailing Address - Country:US
Mailing Address - Phone:602-494-7700
Mailing Address - Fax:602-494-3377
Practice Address - Street 1:16872 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2506
Practice Address - Country:US
Practice Address - Phone:602-494-7700
Practice Address - Fax:602-494-3377
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG87162Medicare UPIN