Provider Demographics
NPI:1588952873
Name:TAKYAR, PLLC.
Entity type:Organization
Organization Name:TAKYAR, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAKYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-429-4043
Mailing Address - Street 1:9341 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2632
Mailing Address - Country:US
Mailing Address - Phone:520-429-4043
Mailing Address - Fax:240-252-5668
Practice Address - Street 1:1702 W ANKLAM RD STE 111
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2606
Practice Address - Country:US
Practice Address - Phone:520-868-0250
Practice Address - Fax:240-252-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI42361Medicare PIN