Healthcare Provider Details

I. General information

NPI: 1790957900
Provider Name (Legal Business Name): KATHLEEN M NORMAN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N TATUM BLVD SUITE F100
PHOENIX AZ
85028-6073
US

IV. Provider business mailing address

11030 N TATUM BLVD SUITE F100
PHOENIX AZ
85028-6073
US

V. Phone/Fax

Practice location:
  • Phone: 602-288-2340
  • Fax: 602-288-2345
Mailing address:
  • Phone: 602-288-2340
  • Fax: 602-288-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22269
License Number StateAZ

VIII. Authorized Official

Name: DR. KATHLEEN M NORMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-288-2340