Provider Demographics
NPI:1073588547
Name:KALEN, VICKI (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:KALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5406
Mailing Address - Country:US
Mailing Address - Phone:520-881-0050
Mailing Address - Fax:
Practice Address - Street 1:3402 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5406
Practice Address - Country:US
Practice Address - Phone:520-881-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ344522086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1376731851OtherGROUP NPI
AZ1588843734OtherGROUP NPI
AZ1750579439OtherGROUP NPI
AZ1831387315OtherGROUP NPI
AZ1033398201OtherGROUP NPI
AZ1770771255OtherGROUP NPI
AZ1033307715OtherGROUP NPI
AZ1457543324OtherGROUP NPI
Z120952OtherGROUP PTAN
AZZ126262OtherMEDICARE PTAN
AZ1740479518OtherGROUP NPI
AZ1871782490OtherGROUP NPI
AZ1396933974OtherGROUP NPI
AZ1447448923OtherGROUP NPI
AZZ126048OtherGROUP PTAN
AZ1780873307OtherGROUP NPI
AZZ126263OtherMEDICARE PTAN
AZ1457543324OtherGROUP NPI
AZ1033307715OtherGROUP NPI
AZ1588843734OtherGROUP NPI
AZZ126262Medicare UPIN
AZ1396933974OtherGROUP NPI
AZ1831387315OtherGROUP NPI