Basic Information
| Provider Information | |||||||||
| NPI: | 1023458742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAREKH | ||||||||
| FirstName: | ASHWIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 W. THUNDERBIRD | ||||||||
| Address2: | BANNER THUNDERBIRD MEDICAL CENTER | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028652627 | ||||||||
| FaxNumber: | 6028652632 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 W. THUNDERBIRD | ||||||||
| Address2: | BANNER THUNDERBIRD MEDICAL CENTER | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028652627 | ||||||||
| FaxNumber: | 6028652632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 01/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 52647 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | R74060 | 01 | AZ | TRAINING PERMIT | OTHER |