Provider Demographics
NPI:1467484659
Name:MCCUAIG, KATHERINE ENA (MD)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ENA
Last Name:MCCUAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 E ARBOR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1309
Mailing Address - Country:US
Mailing Address - Phone:480-827-7979
Mailing Address - Fax:480-654-7173
Practice Address - Street 1:6641 E BAYWOOD AVE
Practice Address - Street 2:SUITE B-3
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1723
Practice Address - Country:US
Practice Address - Phone:480-827-7979
Practice Address - Fax:480-654-7173
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21138208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020048072OtherMEDICARE RAILROAD
F70456Medicare UPIN
AZ62978Medicare ID - Type Unspecified