Healthcare Provider Details

I. General information

NPI: 1083276992
Provider Name (Legal Business Name): KT INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 131
GILBERT AZ
85296-4206
US

IV. Provider business mailing address

2824 N POWER RD # 113-471
MESA AZ
85215-1672
US

V. Phone/Fax

Practice location:
  • Phone: 480-571-3060
  • Fax: 480-571-3061
Mailing address:
  • Phone: 480-571-3060
  • Fax: 480-571-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNETTE ALTAMIRANO LUSKO
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 480-571-3060