Provider Demographics
NPI:1144372905
Name:DESERT KIDNEY ASSOCIATES PLC
Entity type:Organization
Organization Name:DESERT KIDNEY ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHARMINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-834-9039
Mailing Address - Street 1:612 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6041
Mailing Address - Country:US
Mailing Address - Phone:480-834-9039
Mailing Address - Fax:480-964-7802
Practice Address - Street 1:612 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6041
Practice Address - Country:US
Practice Address - Phone:480-834-9039
Practice Address - Fax:480-964-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ526139Medicaid
AZ526139Medicaid
=========OtherTAX ID