MEDICARE: KALID ADAB LLC

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	208M00000X	Hospitalist Physician	45766	AZ

General Provider Information

NPI Number	:	1225383912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALID ADAB LLC

Provider Business Mailing Address
First Line	:	PO BOX 221692
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79913-4692
Country	:	US
Telephone Number	:	702-453-3799
Fax Number	:	702-453-5741

Provider Business Practice Location Address
First Line	:	501 N. NAVAJO DRIVE
Second Line	:
City	:	PAGE
State	:	AZ
Zip	:	86040-1447
Country	:	US
Telephone Number	:	928-645-2424
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTS MGR
Name	:	LORI LABRECQUE
Credential	:
Telephone Number	:	702-453-3799

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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Directions to “KALID ADAB LLC ” Practice Location

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