Healthcare Provider Details

I. General information

NPI: 1043355175
Provider Name (Legal Business Name): KEVIN S. KLOPFENSTEIN M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CALIFORNIA AVE
PARKER AZ
85344-4467
US

IV. Provider business mailing address

400 S CALIFORNIA AVE
PARKER AZ
85344-4467
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-6151
  • Fax: 928-669-8403
Mailing address:
  • Phone: 928-669-6151
  • Fax: 928-669-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15403
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1932
License Number StateAZ

VIII. Authorized Official

Name: DR. KEVIN SCOTT KLOPFENSTEIN
Title or Position: OWNER
Credential: M.D.
Phone: 928-669-6151