Basic Information
Provider Information | |||||||||
NPI: | 1215467923 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NARAYANAN | ||||||||
FirstName: | ANAND | ||||||||
MiddleName: | CHIDAMBARAM | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 850 W RIO SALADO PKWY STE 201 | ||||||||
Address2: |   | ||||||||
City: | TEMPE | ||||||||
State: | AZ | ||||||||
PostalCode: | 852813812 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6026106100 | ||||||||
FaxNumber: | 4803930265 | ||||||||
Practice Location | |||||||||
Address1: | 2215 ROLLINGBROOK DR STE 140 | ||||||||
Address2: |   | ||||||||
City: | BAYTOWN | ||||||||
State: | TX | ||||||||
PostalCode: | 775213693 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2814282487 | ||||||||
FaxNumber: | 2814282784 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2017 | ||||||||
LastUpdateDate: | 11/01/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/01/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125070683 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RN0300X | 036151308 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | T2226 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.