Provider Demographics
NPI:1790957900
Name:KATHLEEN M NORMAN, M.D.
Entity Type:Organization
Organization Name:KATHLEEN M NORMAN, M.D.
Other - Org Name:PARADISE VALLEY WOMEN'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-288-2340
Mailing Address - Street 1:11030 N TATUM BLVD
Mailing Address - Street 2:SUITE F100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6073
Mailing Address - Country:US
Mailing Address - Phone:602-288-2340
Mailing Address - Fax:602-288-2345
Practice Address - Street 1:11030 N TATUM BLVD
Practice Address - Street 2:SUITE F100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6073
Practice Address - Country:US
Practice Address - Phone:602-288-2340
Practice Address - Fax:602-288-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG03907Medicare UPIN