Provider Demographics
NPI:1699076596
Name:KANSAGRA, JANAKKUMAR PRAVINCHANDRA (MD)
Entity type:Individual
Prefix:
First Name:JANAKKUMAR
Middle Name:PRAVINCHANDRA
Last Name:KANSAGRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2122
Mailing Address - Fax:520-838-2245
Practice Address - Street 1:1714 W ANKLAM RD STE 104
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2661
Practice Address - Country:US
Practice Address - Phone:520-624-8935
Practice Address - Fax:520-624-0053
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ56369207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ388995Medicaid