Provider Demographics
NPI:1720084403
Name:SUNDERJI, SHIRAZALI G (MD)
Entity Type:Individual
Prefix:
First Name:SHIRAZALI
Middle Name:G
Last Name:SUNDERJI
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 1:500 W THOMAS RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4224
Mailing Address - Country:US
Mailing Address - Phone:602-406-7048
Mailing Address - Fax:602-406-7650
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-406-7048
Practice Address - Fax:602-406-7650
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080258207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0614026003OtherCIGNA
OH142083OtherCARE CHOICES
OH344428256OtherFRONTPATH
OH344428256044OtherCARESOURCES
CA344428256OtherBEECH STREET
OH000000212142OtherANTHEM COMMERICAL
OH000000212142OtherANTHEM MEDICAID
OH2283309Medicaid
MIC59127OtherHEALTH ALLICANCE PLAN
MI4360620Medicaid
OH344428256OtherFIRST HEALTH
OH4200779OtherAETNA
OH04105OtherPARAMOUNT
OH344428256OtherEMERALD
OHOC92768OtherNATIONWIDE
MIC59127OtherHEALTH ALLICANCE PLAN
OH142083OtherCARE CHOICES
MI4360620Medicaid