Provider Demographics
NPI:1538129358
Name:KLOPFENSTEIN, KEVIN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:KLOPFENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-4467
Mailing Address - Country:US
Mailing Address - Phone:928-669-6151
Mailing Address - Fax:928-669-8403
Practice Address - Street 1:400 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-4467
Practice Address - Country:US
Practice Address - Phone:928-669-6151
Practice Address - Fax:928-669-8403
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ250217Medicaid
CAXPY051020OtherMEDI-CAL
AZAZ0324620OtherBLUE CROSS BLUE SHEILD
Z60920Medicare PIN
AZ250217Medicaid