Individual
DR. SUBHASIS KUMAR MAITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 N DYSART RD, UNIT G-127, AVONDALE, AZ 85392-1011
(623) 882-0077
(623) 882-9977
Mailing address
3400 N DYSART RD, UNIT G-127, AVONDALE, AZ 85392-1011
(623) 882-0077
(623) 882-9977
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31810
AZ
208000000X
Pediatrics Physician
31810
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
833344
AHCCCS
AZ
01
—
DE3350
RAILROAD MEDICARE
AZ
Enumeration date
07/18/2006
Last updated
10/11/2012
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