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General NPI Number Information
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NPI Number | 1962735449
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Entity Type | Organization
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Legal Business Name | KIEBORZ PLLC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 3303 S LINDSAY RD STE 123
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City | GILBERT
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State | AZ
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Zip | 85297-2100
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Country | US
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Telephone | 480-821-9339
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Fax | 480-821-9555
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Provider Business Mailing Address
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Address Line | 6722 N 10TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85013-1008
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Country | US
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Telephone | 602-251-8714
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Fax | 602-251-8899
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY J KIEBORZ
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Credential | DO
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Telephone | 480-821-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3836
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License Number State | AZ
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