Healthcare Provider Details

I. General information

NPI: 1730185430
Provider Name (Legal Business Name): JOSEPH V KLAG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD SUITE 3100
PHOENIX AZ
85032
US

IV. Provider business mailing address

PO BOX 98819
LAS VEGAS NV
89193
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-8644
  • Fax: 602-795-5698
Mailing address:
  • Phone: 602-494-3659
  • Fax: 602-494-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3185
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number3185
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: