Healthcare Provider Details

I. General information

NPI: 1801846993
Provider Name (Legal Business Name): KATALIN H BOLERATZKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 E SOUTHERN AVE STE 1
TEMPE AZ
85282-7612
US

IV. Provider business mailing address

PO BOX 41150
MESA AZ
85274-1150
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-2160
  • Fax: 480-351-8797
Mailing address:
  • Phone: 480-425-2160
  • Fax: 480-839-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA76193
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35876
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: