Basic Information
| Provider Information | |||||||||
| NPI: | 1164068862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DKME MANAGEMENT CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14075 N 106TH PL | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852551748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016823536 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16700 N THOMPSON PEAK PKWY STE 170 | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807507119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2019 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | DAVENPORT | ||||||||
| AuthorizedOfficialFirstName: | DENTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6024755646 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.