Organization
MARICOPA PODIATRY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THARESH UDUPA DPM (OWNER)
(623) 214-3335
Entity
Organization
Contact information
Practice address
12361 W BOLA DR, SUITE 100, SURPRISE, AZ 85378-9021
(623) 214-3335
(623) 214-3956
Mailing address
PO BOX 9350, SURPRISE, AZ 85374-0139
(623) 214-3335
(623) 214-3956
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
0599
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
842171
—
AZ
Enumeration date
01/14/2008
Last updated
09/10/2014
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