Healthcare Provider Details

I. General information

NPI: 1639295843
Provider Name (Legal Business Name): JAMES KALIVAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3442 E PYRENEES PASS
PHOENIX AZ
85018-1553
US

IV. Provider business mailing address

3442 E PYRENEES PASS
PHOENIX AZ
85018-1553
US

V. Phone/Fax

Practice location:
  • Phone: 602-515-1927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number22081
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: