Provider Demographics
NPI:1962989962
Name:ARTISAN PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:ARTISAN PRIMARY CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-853-3437
Mailing Address - Street 1:14815 N DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2145
Mailing Address - Country:US
Mailing Address - Phone:623-277-0759
Mailing Address - Fax:623-200-5519
Practice Address - Street 1:14815 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2145
Practice Address - Country:US
Practice Address - Phone:623-277-0759
Practice Address - Fax:623-200-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty