Provider Demographics
NPI:1952392581
Name:SUN LAKES FAMILY PHYSICIANS LLC
Entity Type:Organization
Organization Name:SUN LAKES FAMILY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-505-2450
Mailing Address - Street 1:10450 E RIGGS RD
Mailing Address - Street 2:STE 114
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7758
Mailing Address - Country:US
Mailing Address - Phone:480-505-2450
Mailing Address - Fax:480-505-2465
Practice Address - Street 1:10450 E RIGGS RD
Practice Address - Street 2:STE 114
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7758
Practice Address - Country:US
Practice Address - Phone:480-505-2450
Practice Address - Fax:480-505-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty