Provider Demographics
NPI:1063717213
Name:SMRITI RANA, MD, PLLC
Entity type:Organization
Organization Name:SMRITI RANA, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SMRITI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-900-2929
Mailing Address - Street 1:13943 N 91ST AVE STE F101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3689
Mailing Address - Country:US
Mailing Address - Phone:623-900-2929
Mailing Address - Fax:602-429-8249
Practice Address - Street 1:13943 N 91ST AVE STE F101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3689
Practice Address - Country:US
Practice Address - Phone:623-900-2929
Practice Address - Fax:602-429-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36053207R00000X
AZ36557207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ694914Medicaid
AZ1063717213Medicare UPIN
AZ694914Medicaid