Provider Demographics
NPI:1811908510
Name:PALANICHAMY, VIJAYAVEL (MD)
Entity type:Individual
Prefix:
First Name:VIJAYAVEL
Middle Name:
Last Name:PALANICHAMY
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 1:3535 E ANDY DEVINE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-3412
Mailing Address - Country:US
Mailing Address - Phone:928-757-2050
Mailing Address - Fax:928-757-2401
Practice Address - Street 1:3535 E ANDY DEVINE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-3412
Practice Address - Country:US
Practice Address - Phone:928-757-2050
Practice Address - Fax:928-757-2020
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27022207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ44268202Medicaid
AZ44268202Medicaid
G44078Medicare UPIN