Basic Information
| Provider Information | |||||||||
| NPI: | 1003078973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIVEDI | ||||||||
| FirstName: | CHIRAG | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 E CAMELBACK RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850145095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239722116 | ||||||||
| FaxNumber: | 6239720521 | ||||||||
| Practice Location | |||||||||
| Address1: | 13640 N 99TH AVE STE 600 | ||||||||
| Address2: | SUITE C-3 | ||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853512861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239722116 | ||||||||
| FaxNumber: | 6239720521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 02/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 005183 | AZ | Y | Other Service Providers | Specialist | 207RG0100X | 25MB07842100 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.