Individual
SUPRIYA PRADHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1840 E BROADWAY RD, TEMPE, AZ 85282-1614
(602) 243-7277
(480) 927-1092
Mailing address
3003 N CENTRAL AVE STE 1600, PHOENIX, AZ 85012-2908
(602) 323-3492
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
62859
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095780
—
AZ
Enumeration date
07/10/2017
Last updated
09/07/2021
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