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NPI Code Detail

MEDICARE: DR. THOMAS EDWARD KIBELSTIS M.D.

MEDICARE: DR. THOMAS EDWARD KIBELSTIS M.D.
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
1207Q00000XFamily Medicine PhysicianMD.13795RLA
2207Q00000XFamily Medicine Physician55189AZ

Other Identifiers

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

General Provider Information

NPI Number : 1215062831
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS EDWARD KIBELSTIS M.D.
Provider Business Mailing Address
First Line : PO BOX 31235
Second Line :
City : TUCSON
State : AZ
Zip : 85751-1235
Country : US
Telephone Number : 520-324-4100
Fax Number :
Provider Business Practice Location Address
First Line : 10350 E DREXEL RD UNIT 110
Second Line :
City : TUCSON
State : AZ
Zip : 85747-9409
Country : US
Telephone Number : 520-324-1727
Fax Number : 520-324-1700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 09/13/2021

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