Basic Information
| Provider Information | |||||||||
| NPI: | 1043355175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KEVIN S. KLOPFENSTEIN M.D. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853444467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286696151 | ||||||||
| FaxNumber: | 9286698403 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853444467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286696151 | ||||||||
| FaxNumber: | 9286698403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | KLOPFENSTEIN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9286696151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1932 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207R00000X | 15403 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1538129358 | 01 | AZ | NPI DR.KLOPFENSTEIN | OTHER | 158539 | 05 | AZ | MEDICAID | 1770543506 | 01 | AZ | NPI GLORIA J. EAGLE P.A. | OTHER | 250217 | 05 | AZ | MEDICAID |