Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 43049 | AZ |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 43049 | AZ |
N | 207XS0117X | Orthopaedic Spine Surgeon | 43049 | AZ |
NPI | 1609056647 |
---|---|
Provider Name | Udaya Kumar Kakarla |
First Address | Phoenix, AZ 85013-4434 |
Second Address | Phoenix, AZ 85013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 14/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
523285 | (05) | AZ |