Provider Demographics
NPI:1780809798
Name:KALE, SUSHANT P (MD)
Entity type:Individual
Prefix:
First Name:SUSHANT
Middle Name:P
Last Name:KALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1325 N LITCHFIELD RD STE 125
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1228
Mailing Address - Country:US
Mailing Address - Phone:623-242-1231
Mailing Address - Fax:623-242-1232
Practice Address - Street 1:1325 N LITCHFIELD RD STE 500
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1228
Practice Address - Country:US
Practice Address - Phone:480-420-0749
Practice Address - Fax:480-420-0732
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1279242084N0400X, 2084V0102X
AZ577232084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127924Medicaid
IL256510107Medicare PIN