Provider Demographics
NPI:1417940123
Name:ORLICK, KATHY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:A
Last Name:ORLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:ORLICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4729 E. SUNRISE DR.
Mailing Address - Street 2:#414
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4534
Mailing Address - Country:US
Mailing Address - Phone:520-731-1110
Mailing Address - Fax:520-731-6582
Practice Address - Street 1:7418 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2306
Practice Address - Country:US
Practice Address - Phone:520-731-1110
Practice Address - Fax:520-731-6582
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11031887OtherCAQH
AZH70068Medicare UPIN
11031887OtherCAQH
71060Medicare PIN