Provider Demographics
NPI:1740346550
Name:GERACE, KATHLEEN (DO)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:GERACE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 E THOMAS RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6078
Mailing Address - Country:US
Mailing Address - Phone:480-941-4400
Mailing Address - Fax:480-941-1100
Practice Address - Street 1:6401 E THOMAS RD
Practice Address - Street 2:STE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6078
Practice Address - Country:US
Practice Address - Phone:480-941-4400
Practice Address - Fax:480-941-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ378522OtherAHCCCS
AZAZ0803970OtherBCBS
AZZ112913Medicare PIN
AZ378522OtherAHCCCS