Individual
DR. REVATI MUMMANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4400 N SCOTTSDALE RD, STE 9841, SCOTTSDALE, AZ 85251-3331
(248) 390-4503
Mailing address
4400 N SCOTTSDALE RD, STE 9841, SCOTTSDALE, AZ 85251-3331
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R71974
AZ
208100000X
Physical Medicine & Rehabilitation Physician
Primary
50905
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R71974
TRAINING PERMIT
AZ
Enumeration date
06/29/2010
Last updated
04/14/2016
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