Provider Demographics
NPI:1871887828
Name:EAST VALLEY DIABETES & ENDOCRINOLOGY PLC
Entity type:Organization
Organization Name:EAST VALLEY DIABETES & ENDOCRINOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WADWEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-782-9531
Mailing Address - Street 1:4100 S LINDSAY RD
Mailing Address - Street 2:STE 130
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1506
Mailing Address - Country:US
Mailing Address - Phone:480-782-9531
Mailing Address - Fax:480-782-9530
Practice Address - Street 1:4100 S LINDSAY RD
Practice Address - Street 2:STE 130
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1506
Practice Address - Country:US
Practice Address - Phone:480-782-9531
Practice Address - Fax:480-782-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44679207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH82367Medicare UPIN
Z147301Medicare PIN