1073588547 NPI number — VICKI KALEN MD

Table of content: VICKI KALEN MD (NPI 1073588547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073588547 NPI number — VICKI KALEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALEN
Provider First Name:
VICKI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073588547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3402 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85716-5406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-881-0050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3402 E BROADWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85716-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-881-0050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X , with the licence number:  34452 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376731851 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1588843734 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1750579439 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1831387315 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1033398201 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1770771255 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1033307715 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1457543324 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z120952 . This is a "GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: Z126262 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1740479518 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1871782490 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1396933974 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1447448923 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z126048 . This is a "GROUP PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1780873307 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z126263 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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