Individual ProviderShanmugam MukundanInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address10401 W Thunderbird Blvd, Sun City, AZ 85351-3004(623) 876-5622PECOS EnrollmentBased on the most recent information from CMS, provider Shanmugam Mukundan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1730191610Provider TypeIndividualFull NameMukundan, ShanmugamCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date8/12/2006Last Updated8/31/2010Contact InformationPractice LocationPractice Address10401 W Thunderbird Blvd, Sun City, AZ 85351-3004Phone(623) 876-5622Fax(623) 815-2931Mailing LocationMailing Address10401 W Thunderbird Blvd, Sun City, AZ 85351-3004Phone(623) 876-5622Fax(623) 815-2931Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense37254ArizonaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense0101229163VirginiaProvider IdentifiersIDDescriptionIssuerID690545DescriptionOtherIssuerNCPPOIDG0157201DescriptionOtherIssuerRAILROAD MEDICAREIDK012DescriptionOtherIssuerBLUECROSS CAREFIRST NCAIDAETNADescriptionOtherIssuer201020956ID010151431DescriptionMedicaidIssuerUnlistedVirginiaID201020956DescriptionOtherIssuerCIGNAID2128136DescriptionOtherIssuerALLIANCEID8128136DescriptionOtherIssuerOPTIMUM CHOICEID13965DescriptionOtherIssuerANTHEMID8128136DescriptionOtherIssuerUNITED HEALTH CARE