Basic Information
| Provider Information | |||||||||
| NPI: | 1689676256 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHWATUKEE PEDIATRICS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15715 S 46TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804966444 | ||||||||
| FaxNumber: | 4804969688 | ||||||||
| Practice Location | |||||||||
| Address1: | 15715 S 46TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804966444 | ||||||||
| FaxNumber: | 4804969688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | KUTLER | ||||||||
| AuthorizedOfficialFirstName: | MARY JO | ||||||||
| AuthorizedOfficialMiddleName: | FOA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4804966444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2633 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.