MEDICARE: THE PLASTIC SURGERY CENTER AT KIERLAND

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	261QA1903X	Ambulatory Surgical Clinic/Center	MD21593	AZ

General Provider Information

NPI Number	:	1407004229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PLASTIC SURGERY CENTER AT KIERLAND

Provider Business Mailing Address
First Line	:	7102 E ACOMA DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-2771
Country	:	US
Telephone Number	:	480-483-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7102 E ACOMA DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-2771
Country	:	US
Telephone Number	:	480-483-6200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND MEDICAL DIRECTOR
Name	:	DR. RONALD JOSEPH CANIGLIA
Credential	:	M.D.
Telephone Number	:	480-483-6200

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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Directions to “THE PLASTIC SURGERY CENTER AT KIERLAND ” Practice Location

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