Healthcare Provider Details

I. General information

NPI: 1295281863
Provider Name (Legal Business Name): KUREFUSION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4862 E. BASELINE ROAD SUITE 108
MESA AZ
85206-4668
US

IV. Provider business mailing address

4838 E. BASELINE ROAD SUITE 108
MESA AZ
85206-4672
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-2404
  • Fax: 480-981-2407
Mailing address:
  • Phone: 480-981-2400
  • Fax: 480-981-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number33634
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number33634
License Number StateAZ

VIII. Authorized Official

Name: BRIAN JEFFREY DELISIO
Title or Position: MANAGING PARTNER, PRESIDENT
Credential: M.D.
Phone: 480-981-2400