Provider Demographics
NPI:1548355894
Name:AMITA D TRIVEDI MD
Entity type:Organization
Organization Name:AMITA D TRIVEDI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-623-2642
Mailing Address - Street 1:1702 W ANKLAM RD
Mailing Address - Street 2:# 111
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2606
Mailing Address - Country:US
Mailing Address - Phone:520-623-2642
Mailing Address - Fax:520-623-6162
Practice Address - Street 1:1702 W ANKLAM RD
Practice Address - Street 2:111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2606
Practice Address - Country:US
Practice Address - Phone:520-623-2642
Practice Address - Fax:520-623-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12415207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID NUMBER