| NPI | 1770160269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JOSEPH KLEDZIK Member 928-255-5191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207T00000X Neurological Surgery | |
| 208100000X Physical Medicine & Rehabilitation | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2023-02-02 |