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General NPI Number Information
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NPI Number | 1750612024
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Entity Type | Organization
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Legal Business Name | MELISSA KYRIMIS, MD PLC
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 5448 WHITE MOUNTAIN BLVD 200
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City | LAKESIDE
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State | AZ
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Zip | 85929-5739
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Country | US
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Telephone | 928-535-6667
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Fax |
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Provider Business Mailing Address
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Address Line | 5448 WHITE MOUNTAIN BLVD 200
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City | LAKESIDE
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State | AZ
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Zip | 85929-5739
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | CARISSA NICKOLS
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Credential |
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Telephone | 928-535-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26344
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License Number State | AZ
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