Healthcare Provider Details

I. General information

NPI: 1235125840
Provider Name (Legal Business Name): MKRP INDUSTRIES INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD SUITE 130
GILBERT AZ
85234-2471
US

IV. Provider business mailing address

2451 E BASELINE RD SUITE 130
GILBERT AZ
85234-2471
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-2213
  • Fax: 480-507-0677
Mailing address:
  • Phone: 480-507-2213
  • Fax: 480-507-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number33546
License Number StateAZ

VIII. Authorized Official

Name: DENNIS PICKERING
Title or Position: OWNER
Credential:
Phone: 602-889-7550