Provider Demographics
NPI:1083276992
Name:KT INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:KT INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:ALTAMIRANO
Authorized Official - Last Name:LUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-571-3060
Mailing Address - Street 1:2824 N POWER RD # 113-471
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1672
Mailing Address - Country:US
Mailing Address - Phone:480-571-3060
Mailing Address - Fax:480-571-3061
Practice Address - Street 1:633 E RAY RD STE 131
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4206
Practice Address - Country:US
Practice Address - Phone:480-571-3060
Practice Address - Fax:480-571-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center