Provider Demographics
NPI:1891088563
Name:AMMUNJE, ASHWINI NAYAK (MD)
Entity type:Individual
Prefix:
First Name:ASHWINI
Middle Name:NAYAK
Last Name:AMMUNJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHWINI
Other - Middle Name:NAYAK
Other - Last Name:AMMUNJE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9139 W THUNDERBIRD RD STE 275
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4922
Mailing Address - Country:US
Mailing Address - Phone:623-900-5181
Mailing Address - Fax:623-900-5290
Practice Address - Street 1:9139 W THUNDERBIRD RD STE 275
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4922
Practice Address - Country:US
Practice Address - Phone:623-900-5181
Practice Address - Fax:623-900-5290
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48269208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ943914Medicaid
AZZ196566OtherMEDICARE PTAN