Provider Demographics
NPI:1609102110
Name:KUMARAVEL, SREE DEVI (MD)
Entity type:Individual
Prefix:
First Name:SREE DEVI
Middle Name:
Last Name:KUMARAVEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 N 16TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5344
Mailing Address - Country:US
Mailing Address - Phone:026-920-3318
Mailing Address - Fax:602-926-8937
Practice Address - Street 1:2606 E GREENWAY PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3601
Practice Address - Country:US
Practice Address - Phone:602-920-3318
Practice Address - Fax:602-926-8937
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ166584Medicare PIN