Provider Demographics
NPI:1487645685
Name:PAIGE, KENNETH D (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:PAIGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 E RIGGS RD #114
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7760
Mailing Address - Country:US
Mailing Address - Phone:480-505-2450
Mailing Address - Fax:480-505-2465
Practice Address - Street 1:10450 E RIGGS RD #114
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7760
Practice Address - Country:US
Practice Address - Phone:480-505-2450
Practice Address - Fax:480-505-2465
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ65318OtherMEDICARE PROVIDER NUMBER
AZG34481Medicare UPIN