Healthcare Provider Details

I. General information

NPI: 1962735449
Provider Name (Legal Business Name): KIEBORZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD STE 123
GILBERT AZ
85297-2100
US

IV. Provider business mailing address

6722 N 10TH AVE
PHOENIX AZ
85013-1008
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-9339
  • Fax: 480-821-9555
Mailing address:
  • Phone: 602-251-8714
  • Fax: 602-251-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3836
License Number StateAZ

VIII. Authorized Official

Name: TIMOTHY J KIEBORZ
Title or Position: OWNER
Credential: DO
Phone: 480-821-9555