Provider Demographics
NPI:1124133020
Name:UPPAL, NEENA K (MD)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:K
Last Name:UPPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14674 W MOUNTAIN VIEW BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2705
Mailing Address - Country:US
Mailing Address - Phone:623-544-6860
Mailing Address - Fax:623-544-6861
Practice Address - Street 1:14674 W MOUNTAIN VIEW BLVD # 200
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-544-6860
Practice Address - Fax:623-544-6861
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ423533Medicaid
AZ67680Medicare ID - Type Unspecified
AZ423533Medicaid