Physician Compare National (NPI:1629010202)

HEALTHCARE PROVIDER: TIMOTHY KIEBORZ DO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629010202
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860464633
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040811001001
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIEBORZ
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1800 E VAN BUREN ST
	Group Practice or individual's line 1 address
City	PHOENIX
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	850063742
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	030083
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ABRAZO SCOTTSDALE CAMPUS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	030092
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HONORHEALTH DEER VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	030123
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SCOTTSDALE THOMPSON PEAK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	030014
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	HONORHEALTH JOHN C LINCOLN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	030094
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	ARROWHEAD HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1629010202)

HEALTHCARE PROVIDER: TIMOTHY KIEBORZ DO

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information