Provider Demographics
NPI:1689676256
Name:AHWATUKEE PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:AHWATUKEE PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:FOA
Authorized Official - Last Name:KUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-496-6444
Mailing Address - Street 1:15715 S 46TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0438
Mailing Address - Country:US
Mailing Address - Phone:480-496-6444
Mailing Address - Fax:480-496-9688
Practice Address - Street 1:15715 S 46TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0438
Practice Address - Country:US
Practice Address - Phone:480-496-6444
Practice Address - Fax:480-496-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF58545Medicare UPIN