Provider Demographics
NPI:1184696122
Name:KIDWELL, ESTELLA M
Entity type:Individual
Prefix:
First Name:ESTELLA
Middle Name:M
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:M
Other - Last Name:KIDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVENUE, 6TH FLOOR
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, 6TH FLOOR
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721
Mailing Address - Country:US
Mailing Address - Phone:520-694-8888
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVENUE, 6TH FLOOR
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY, 6TH FLOOR
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-694-0235
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1631122084N0400X
OH35C.0006012084N0400X
AZ477182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017036YTFMedicare PIN
C26255Medicare UPIN
DC018515G93Medicare PIN