MEDICARE: KIRK PUTTLITZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	26875	AZ
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	29875	AZ
3	208VP0000X	Pain Medicine Physician	29875	AZ
4	208VP0014X	Interventional Pain Medicine Physician	26875	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205807971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK PUTTLITZ MD

Provider Business Mailing Address
First Line	:	18444 N 25TH AVE
Second Line	:	STE 310
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1266
Country	:	US
Telephone Number	:	623-537-5600
Fax Number	:	866-939-2673

Provider Business Practice Location Address
First Line	:	18444 N 25TH AVE
Second Line	:	STE 210
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1264
Country	:	US
Telephone Number	:	623-537-5600
Fax Number	:	866-939-2673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/08/2025

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Directions to “ KIRK PUTTLITZ MD” Practice Location

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