Provider Demographics
NPI:1164605333
Name:DAVID BLIKLEN, M.D., P.C.
Entity Type:Organization
Organization Name:DAVID BLIKLEN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLIKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-843-3811
Mailing Address - Street 1:5757 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE E 151
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4641
Mailing Address - Country:US
Mailing Address - Phone:602-843-3811
Mailing Address - Fax:602-843-0044
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:SUITE E151
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4685
Practice Address - Country:US
Practice Address - Phone:602-843-3811
Practice Address - Fax:602-843-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ172752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ273441-01Medicaid
C99158Medicare UPIN
AZZMD17275Medicare PIN