Provider Demographics
NPI:1710382767
Name:NAEGELE MEDICAL INC.
Entity Type:Organization
Organization Name:NAEGELE MEDICAL INC.
Other - Org Name:NAEGELE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEGELE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-250-3410
Mailing Address - Street 1:1308 N STOCKTON HILL RD
Mailing Address - Street 2:SUITE A386
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5139
Mailing Address - Country:US
Mailing Address - Phone:708-250-3410
Mailing Address - Fax:
Practice Address - Street 1:3178 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0950
Practice Address - Country:US
Practice Address - Phone:928-757-7011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005573207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty