Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 20774 | AZ |
NPI | 1063407260 |
---|---|
Provider Name | Dr. Susan J Kalota |
First Address | Tucson, AZ 85715-3808 |
Second Address | Tucson, AZ 85715-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 10/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F31369 | (02) | AZ |