Provider Demographics
NPI:1508946849
Name:TYPPO, KATRI V (MD)
Entity Type:Individual
Prefix:MS
First Name:KATRI
Middle Name:V
Last Name:TYPPO
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 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-626-5485
Mailing Address - Fax:520-626-6571
Practice Address - Street 1:1501 N CAMPBELL AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724
Practice Address - Country:US
Practice Address - Phone:520-626-5485
Practice Address - Fax:520-626-6571
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL95262080P0203X
AZ421612080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168400301Medicaid
TX168400301Medicaid
8C7494Medicare ID - Type Unspecified