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Individual

NICHOLAS R BASTIAMPILLAI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
603 N WILMOT RD, SUITE 201, TUCSON, AZ 85711-2701
(520) 790-1556
(520) 620-9719
Mailing address
PO BOX 30370, TUCSON, AZ 85751-0370
(520) 722-0777
(520) 290-9713

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3497
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3497
AZ STATE MEDICAL LICENSE
AZ
05
482919
AZ
01
AZ0769110
BCBSAZ
AZ
Enumeration date
06/19/2006
Last updated
03/26/2024
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