Provider Demographics
NPI:1104880996
Name:KHERA, GORDI (MD)
Entity type:Individual
Prefix:DR
First Name:GORDI
Middle Name:
Last Name:KHERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 W THUNDERBIRD RD STE E4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4651
Mailing Address - Country:US
Mailing Address - Phone:602-296-7224
Mailing Address - Fax:602-535-5284
Practice Address - Street 1:5620 W THUNDERBIRD RD STE E4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4651
Practice Address - Country:US
Practice Address - Phone:602-296-7224
Practice Address - Fax:602-535-5284
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF97233Medicare UPIN