Provider Demographics
NPI:1154322907
Name:STOECKMANN, KYLE J (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:STOECKMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21300 N JOHN WAYNE PKWY
Mailing Address - Street 2:STE123
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-8979
Mailing Address - Country:US
Mailing Address - Phone:520-494-7778
Mailing Address - Fax:520-494-7779
Practice Address - Street 1:21300 N JOHN WAYNE PARKWAY
Practice Address - Street 2:STE 123
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239
Practice Address - Country:US
Practice Address - Phone:520-494-7778
Practice Address - Fax:520-494-7779
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ950164Medicaid
H50071Medicare UPIN
AZZ112439Medicare PIN