Healthcare Provider Details

I. General information

NPI: 1396570750
Provider Name (Legal Business Name): KAILIE SAGE DUGGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2971 W ELLIOT RD
CHANDLER AZ
85224-1636
US

IV. Provider business mailing address

6385 S ROGER WAY
CHANDLER AZ
85249-4816
US

V. Phone/Fax

Practice location:
  • Phone: 480-733-5483
  • Fax: 480-733-7080
Mailing address:
  • Phone: 602-931-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number10668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: