Healthcare Provider Details

I. General information

NPI: 1669505145
Provider Name (Legal Business Name): SALLY KALPAKOFF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5656
US

IV. Provider business mailing address

6575 N PRAYING MONK RD
PARADISE VALLEY AZ
85253-4085
US

V. Phone/Fax

Practice location:
  • Phone: 602-530-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: