Provider Demographics
NPI:1265662274
Name:STUART, KATHLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 E. PARADISE FALLS DR.
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-290-5888
Mailing Address - Fax:520-290-5551
Practice Address - Street 1:3945 E PARADISE FALLS DR
Practice Address - Street 2:STE 201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6683
Practice Address - Country:US
Practice Address - Phone:520-290-5888
Practice Address - Fax:520-290-5551
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005935207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ737638Medicaid
AZ737638Medicaid