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NPI Code Detail

MEDICARE: KARLA M LODGE PA-C

MEDICARE: KARLA M LODGE PA-C
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
1363AM0700XMedical Physician Assistant2427AZ

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 : 1306003678
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARLA M LODGE PA-C
Provider Business Mailing Address
First Line : PO BOX 2527
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85252-2527
Country : US
Telephone Number : 602-703-3197
Fax Number :
Provider Business Practice Location Address
First Line : 2640 W BASELINE RD STE 111
Second Line :
City : PHOENIX
State : AZ
Zip : 85041-6492
Country : US
Telephone Number : 480-677-8282
Fax Number : 888-316-1686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2008
Last Update Date : 01/29/2021

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Directions to “ KARLA M LODGE PA-C” Practice Location

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