Provider Demographics
NPI:1619058260
Name:EDE, KALEO C (MD)
Entity Type:Individual
Prefix:DR
First Name:KALEO
Middle Name:C
Last Name:EDE
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 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-933-0909
Practice Address - Fax:602-933-0911
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91852208000000X, 207R00000X, 2080P0216X
AZ377342080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ335953Medicaid
CA00A918520Medicaid
AZ335953Medicaid
CAWA91852AMedicare ID - Type UnspecifiedPPIN #