Basic Information
| Provider Information | |||||||||
| NPI: | 1811121403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COAN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | ELISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 N CENTRAL AVE STE 1001 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148055020 | ||||||||
| FaxNumber: | 4148055771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2009 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 63910 | WI | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208600000X | 63910 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 43314 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 161961 | 05 | AZ | MEDICAID | 1811121403 | 05 | WI | MEDICAID |