Provider Demographics
NPI:1043355175
Name:KEVIN S. KLOPFENSTEIN M.D. P.C.
Entity type:Organization
Organization Name:KEVIN S. KLOPFENSTEIN M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KLOPFENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-669-6151
Mailing Address - Street 1:400 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-4467
Mailing Address - Country:US
Mailing Address - Phone:928-669-6151
Mailing Address - Fax:928-669-8403
Practice Address - Street 1:400 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-4467
Practice Address - Country:US
Practice Address - Phone:928-669-6151
Practice Address - Fax:928-669-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15403207R00000X
AZ1932363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1538129358OtherNPI DR.KLOPFENSTEIN
AZ158539Medicaid
AZ1770543506OtherNPI GLORIA J. EAGLE P.A.
AZ250217Medicaid
Z60921Medicare PIN
Z60919Medicare PIN
AZ250217Medicaid
AZS98946Medicare UPIN
Z60920Medicare PIN