Healthcare Provider Details

I. General information

NPI: 1942346267
Provider Name (Legal Business Name): EVAN W KLIGMAN M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 E FORT LOWELL RD
TUCSON AZ
85712-1110
US

IV. Provider business mailing address

4635 E FORT LOWELL RD
TUCSON AZ
85712-1110
US

V. Phone/Fax

Practice location:
  • Phone: 520-326-9355
  • Fax: 520-795-1445
Mailing address:
  • Phone: 520-326-9355
  • Fax: 520-795-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EVAN W KLIGMAN
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 520-742-2200