Provider Demographics
NPI:1427269638
Name:KAVATHIA, DASHANT SUBHASH (MD)
Entity type:Individual
Prefix:
First Name:DASHANT
Middle Name:SUBHASH
Last Name:KAVATHIA
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 1:3155 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204
Mailing Address - Country:US
Mailing Address - Phone:480-325-8173
Mailing Address - Fax:480-325-8179
Practice Address - Street 1:3155 E SOUTHERN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204
Practice Address - Country:US
Practice Address - Phone:480-325-8173
Practice Address - Fax:480-325-8179
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315021609207RP1001X
AZ44816207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78334OtherGROUP MEDICARE PIN
AZ642740Medicaid
AZ642740Medicaid
AZZ147721Medicare PIN