Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0599 | AZ |
N | 222Z00000X | Podiatrist | 0599 | AZ |
N | 213EP1101X | Primary Podiatric Medicine | 0599 | AZ |
N | 2081S0010X | Sports Medicine | 0599 | AZ |
N | 213ES0000X | Sports Medicine | 0599 | AZ |
Y | 213ES0131X | Foot Surgery | 0599 | AZ |
NPI | 1275537607 |
---|---|
Provider Name | Dr. Tharesh Udupa |
First Address | Phoenix, AZ 85023-1261 |
Second Address | Sun City, AZ 85375-5855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 19/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
842171 | (05) | AZ |
U88958 | (02) | AZ |