Provider Demographics
NPI:1912903535
Name:NACHIAPPAN, MUTHIAH (MD)
Entity Type:Individual
Prefix:
First Name:MUTHIAH
Middle Name:
Last Name:NACHIAPPAN
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:PO BOX 29211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9211
Mailing Address - Country:US
Mailing Address - Phone:602-273-6770
Mailing Address - Fax:602-889-0489
Practice Address - Street 1:2400 S AVE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:602-273-6770
Practice Address - Fax:602-889-0489
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036165846207L00000X
AZ34223207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG28151Medicare UPIN
AZ103309Medicare ID - Type Unspecified