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NPI Code Detail

MEDICARE: DR. KRISTA DEANN PELLICORE M.D.

MEDICARE: DR. KRISTA DEANN PELLICORE 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 Physician01057388AIN
2207Q00000XFamily Medicine Physician48328AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000305690OTHERBCBS PROVIDER NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235174731
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTA DEANN PELLICORE M.D.
Provider Business Mailing Address
First Line : 3101 N CENTRAL AVE STE 550
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2635
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-682-7455
Provider Business Practice Location Address
First Line : 506 E WESTERN AVE STE 104
Second Line :
City : AVONDALE
State : AZ
Zip : 85323-2422
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-230-3086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 04/22/2025

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