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14810 N Del Webb Blvd Sun City AZ 85351-2146 | |
| (623) 261-5258 | |
| (623) 432-7006 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 14810 N Del Webb Blvd, Sun City, Arizona |
| Authorized Official Name and Position | Malar Kuppan (NP/MANAGER AND MEMBER) |
| Authorized Official Contact | 6232615258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5519 W Banff Ln Glendale AZ 85306-3045 Ph: (623) 261-5258 | 14810 N Del Webb Blvd Sun City AZ 85351-2146 Ph: (623) 261-5258 |
| NPI Number | 1912575093 |
|---|---|
| Provider Enumeration Date | 06/15/2021 |
| Last Update Date | 01/08/2025 |
| Certification Date | 01/08/2025 |
| Medicare PECOS PAC ID | 9133502529 |
|---|---|
| Medicare Enrollment ID | O20220824001707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912575093 | NPI | - | NPPES |
| Provider Name | Malar Kuppan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295216190 PECOS PAC ID: 1456695998 Enrollment ID: I20181210002790 |
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