Provider Demographics
NPI:1841288248
Name:KAUL, SHIVANI S (MD)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:S
Last Name:KAUL
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 29834
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9834
Mailing Address - Country:US
Mailing Address - Phone:602-553-8400
Mailing Address - Fax:602-553-8408
Practice Address - Street 1:2020 N CENTRAL AVE
Practice Address - Street 2:STE 1010
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4501
Practice Address - Country:US
Practice Address - Phone:602-553-8400
Practice Address - Fax:602-553-8408
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ867434-17Medicaid
AZI00948Medicare UPIN
AZZ103781Medicare PIN