Healthcare Provider Details

I. General information

NPI: 1992804280
Provider Name (Legal Business Name): SCOTT EDWARD KLEWER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N WILMOT RD SUITE #101
TUCSON AZ
85711
US

IV. Provider business mailing address

2701 E ELVIRA RD
TUCSON AZ
85756-7124
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-9988
  • Fax: 520-694-9917
Mailing address:
  • Phone: 520-626-6508
  • Fax: 520-626-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number23838
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number23838
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: