Provider Demographics
NPI:1932365251
Name:JAGADISH, ANUBHAV PUTTANNIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUBHAV
Middle Name:PUTTANNIAH
Last Name:JAGADISH
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 1:1325 N LITCHFIELD RD STE 125
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1215
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 125
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1215
Practice Address - Country:US
Practice Address - Phone:623-242-1231
Practice Address - Fax:623-242-1232
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136700207X00000X, 207XS0117X
AZ59580207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-136700Medicaid
ILF400186246Medicare PIN
ILF400186242Medicare PIN