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General NPI Number Information
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NPI Number | 1164605333
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Entity Type | Organization
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Legal Business Name | DAVID BLIKLEN, M.D., P.C.
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 5757 W THUNDERBIRD RD SUITE E151
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City | GLENDALE
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State | AZ
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Zip | 85306-4685
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Country | US
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Telephone | 602-843-3811
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Fax | 602-843-0044
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Provider Business Mailing Address
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Address Line | 5757 W THUNDERBIRD RD SUITE E 151
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City | GLENDALE
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State | AZ
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Zip | 85306-4641
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Country | US
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Telephone | 602-843-3811
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Fax | 602-843-0044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID BLIKLEN
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Credential | M.D.
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Telephone | 602-843-3811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17275
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License Number State | AZ
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