Healthcare Provider Details

I. General information

NPI: 1942233689
Provider Name (Legal Business Name): EVAN W KLIGMAN MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 N ALVERNON WAY SUITE 200
TUCSON AZ
85712-1500
US

IV. Provider business mailing address

2802 N ALVERNON WAY SUITE 200
TUCSON AZ
85712-1500
US

V. Phone/Fax

Practice location:
  • Phone: 520-326-0850
  • Fax: 520-326-0849
Mailing address:
  • Phone: 520-326-0850
  • Fax: 520-326-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number26437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: