Provider Demographics
NPI:1174700272
Name:AGRAWAL, KUSH (MD)
Entity type:Individual
Prefix:DR
First Name:KUSH
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N DOBSON RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:480-899-2020
Mailing Address - Fax:
Practice Address - Street 1:333 N DOBSON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:480-899-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136299207RI0011X
TN53874207RI0011X
AZ51949207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ191672Medicare PIN
MS302I110969Medicare PIN