Healthcare Provider Details

I. General information

NPI: 1225383912
Provider Name (Legal Business Name): KALID ADAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N. NAVAJO DRIVE
PAGE AZ
86040-1447
US

IV. Provider business mailing address

PO BOX 221692
EL PASO TX
79913-4692
US

V. Phone/Fax

Practice location:
  • Phone: 928-645-2424
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number45766
License Number StateAZ

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCOUNTS MGR
Credential:
Phone: 702-453-3799