Basic Information
| Provider Information | |||||||||
| NPI: | 1720084403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDERJI | ||||||||
| FirstName: | SHIRAZALI | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W THOMAS RD | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024067048 | ||||||||
| FaxNumber: | 6024067650 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024067048 | ||||||||
| FaxNumber: | 6024067650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 03/28/2016 | ||||||||
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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 | 207VM0101X | 35080258 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0614026003 | 01 | OH | CIGNA | OTHER | 142083 | 01 | OH | CARE CHOICES | OTHER | 344428256 | 01 | OH | FRONTPATH | OTHER | 344428256044 | 01 | OH | CARESOURCES | OTHER | 344428256 | 01 | CA | BEECH STREET | OTHER | 000000212142 | 01 | OH | ANTHEM COMMERICAL | OTHER | 000000212142 | 01 | OH | ANTHEM MEDICAID | OTHER | 2283309 | 05 | OH | MEDICAID | C59127 | 01 | MI | HEALTH ALLICANCE PLAN | OTHER | 4360620 | 05 | MI | MEDICAID | 344428256 | 01 | OH | FIRST HEALTH | OTHER | 4200779 | 01 | OH | AETNA | OTHER | 04105 | 01 | OH | PARAMOUNT | OTHER | 344428256 | 01 | OH | EMERALD | OTHER | OC92768 | 01 | OH | NATIONWIDE | OTHER |