Basic Information
| Provider Information | |||||||||
| NPI: | 1457319659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEDIA | ||||||||
| FirstName: | NAVIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6567 E CARONDELET DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208863432 | ||||||||
| FaxNumber: | 5208860169 | ||||||||
| Practice Location | |||||||||
| Address1: | 6567 E CARONDELET DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208863432 | ||||||||
| FaxNumber: | 5208860169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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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 | 207R00000X | 34008475 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4449 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 174400000X | N | Other Service Providers | Specialist | 207RC0000X | 4449 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | 4449 | AZ | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
ID Information
| ID | Type | State | Issuer | Description | Z115613 | 01 | AZ | MEDICARE PTAN | OTHER | 1093810707 | 01 | AZ | MEDICARE GROUP NPI | OTHER | 2561311 | 05 | OH | MEDICAID |