Provider Demographics
NPI:1609929538
Name:MEKA, MADHAVI (MD)
Entity type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:MEKA
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 1:2315 E HATCHER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4600
Mailing Address - Country:US
Mailing Address - Phone:912-441-2712
Mailing Address - Fax:
Practice Address - Street 1:4550 E BELL RD
Practice Address - Street 2:BUILDING 8, SUITE 208
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9393
Practice Address - Country:US
Practice Address - Phone:817-684-2700
Practice Address - Fax:817-684-2709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001738208600000X
TXP11062086S0129X
AZ468542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296447002Medicaid
TX296447001Medicaid
TXTXB141489Medicare PIN
TX296447002Medicaid