Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 26286 | AZ |
Y | 207RI0011X | Interventional Cardiology | 26286 | AZ |
NPI | 1104860337 |
---|---|
Provider Name | Dr. Madhavagopal V. Cherukuri |
First Address | Phoenix, AZ 85016-4352 |
Second Address | Phoenix, AZ 85016-4352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BC5899717 | DEA (01) | AZ |
H93392 | (02) | AZ |