Basic Information
| Provider Information | |||||||||
| NPI: | 1417055708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATTABI KALYANAM MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5425 E BELL RD | ||||||||
| Address2: | SUITE 115 BLDG 3 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852546007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239150270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5425 E BELL RD | ||||||||
| Address2: | SUITE 115 BLDG 3 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852546007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239150270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KALYANAM | ||||||||
| AuthorizedOfficialFirstName: | PATTABI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6239150270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 27627 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.