Provider Demographics
NPI:1639428881
Name:JENNIFER L KALMER MD PC
Entity Type:Organization
Organization Name:JENNIFER L KALMER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:KALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-551-5448
Mailing Address - Street 1:9630 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6267
Mailing Address - Country:US
Mailing Address - Phone:480-551-5448
Mailing Address - Fax:480-551-5378
Practice Address - Street 1:9630 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6267
Practice Address - Country:US
Practice Address - Phone:480-551-5448
Practice Address - Fax:480-551-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30502208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ717449Medicaid
AZ71118Medicare UPIN