Provider Demographics
NPI:1700878873
Name:GALEKOVIC, KATHLEEN A (NPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:GALEKOVIC
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 N TATUM BLVD
Mailing Address - Street 2:STE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6016
Mailing Address - Country:US
Mailing Address - Phone:480-968-7600
Mailing Address - Fax:480-968-8003
Practice Address - Street 1:3303 E BASELINE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2738
Practice Address - Country:US
Practice Address - Phone:480-968-7600
Practice Address - Fax:480-968-8003
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P40602Medicare UPIN
AZ72906Medicare ID - Type Unspecified