Basic Information
| Provider Information | |||||||||
| NPI: | 1235189077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KACZAR | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 35380 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891335380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028388265 | ||||||||
| FaxNumber: | 7028043788 | ||||||||
| Practice Location | |||||||||
| Address1: | 8041 N BLACK CANYON HWY STE I | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850214173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022490115 | ||||||||
| FaxNumber: | 6022490838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 26301 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.