Healthcare Provider Details

I. General information

NPI: 1356531859
Provider Name (Legal Business Name): HORST UWE KLUEPPELBERG MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR BANNER MD ANDERSON CANCER CENTER
GILBERT AZ
85234
US

IV. Provider business mailing address

2940 E BANNER GATEWAY DR STE 450 BANNER CANCER CENTER SPECIALISTS, LLC
GILBERT AZ
85234-2178
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-4607
Mailing address:
  • Phone: 480-256-3609
  • Fax: 480-256-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number40091
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: