Provider Demographics
NPI:1033176631
Name:STONE, KATHLEEN M (DPM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:STONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8325 W HAPPY VALLEY RD
Mailing Address - Street 2:UNIT 105
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4361
Mailing Address - Country:US
Mailing Address - Phone:602-547-2111
Mailing Address - Fax:602-547-0473
Practice Address - Street 1:8325 W HAPPY VALLEY RD
Practice Address - Street 2:UNIT 105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4361
Practice Address - Country:US
Practice Address - Phone:602-547-2111
Practice Address - Fax:602-547-0473
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70056901Medicaid
AZT42190Medicare UPIN
AZ70056901Medicaid
AZZ67228Medicare ID - Type UnspecifiedGROUP ID