Provider Demographics
NPI:1174738389
Name:ROKKAM, VAMSI (MD)
Entity type:Individual
Prefix:
First Name:VAMSI
Middle Name:
Last Name:ROKKAM
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 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:6622 N 91ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2569
Practice Address - Country:US
Practice Address - Phone:623-547-4668
Practice Address - Fax:623-535-7869
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40917207R00000X
AZ49713207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2391971OtherCIGNA - CMA
IN7100006180Medicaid
KY000000528055OtherANTHEM - CMA
KY000023028OOtherHUMANA - CMA
KY089054OtherSIHO
KY50015843OtherPASSPORT - CMA
AZZ171026OtherMEDICARE PTAN - AZ
IN200877630OtherMEDICAID - IN
KY2858299000OtherPASSPORT ADVTG - CMA
KYP00439730OtherRAILROAD MEDICARE - KY
AZ958702Medicaid
KY0998869OtherMEDICARE - KY
KYTP218OtherMEDICAL LICENSE