Healthcare Provider Details

I. General information

NPI: 1740975515
Provider Name (Legal Business Name): KALONI PHILIPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

1811 E MCMURRAY BLVD
CASA GRANDE AZ
85122-5404
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5011
  • Fax:
Mailing address:
  • Phone: 520-374-6530
  • Fax: 520-374-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76361
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: