Provider Demographics
NPI:1215936570
Name:GOEL, SUDHIR KUMAR (MD)
Entity type:Individual
Prefix:
First Name:SUDHIR
Middle Name:KUMAR
Last Name:GOEL
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 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2445
Mailing Address - Country:US
Mailing Address - Phone:602-242-7500
Mailing Address - Fax:602-433-2644
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2445
Practice Address - Country:US
Practice Address - Phone:602-242-7500
Practice Address - Fax:602-433-2644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G85267Medicare UPIN