MEDICARE: EVAN W KLIGMAN MD PC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	26437	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Z113016	OTHER	AZ	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1942233689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN W KLIGMAN MD PC

Provider Business Mailing Address
First Line	:	2802 N ALVERNON WAY
Second Line	:	SUITE 200
City	:	TUCSON
State	:	AZ
Zip	:	85712-1500
Country	:	US
Telephone Number	:	520-326-0850
Fax Number	:	520-326-0849

Provider Business Practice Location Address
First Line	:	2802 N ALVERNON WAY
Second Line	:	SUITE 200
City	:	TUCSON
State	:	AZ
Zip	:	85712-1500
Country	:	US
Telephone Number	:	520-326-0850
Fax Number	:	520-326-0849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	06/29/2015

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Directions to “ EVAN W KLIGMAN MD PC” Practice Location

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