Detlefs, Corey L
Detlefs, Corey L is an individual health care provider with primary practice located at 1441 N 12Th St Fl 1 , Phoenix AZ 85006-2837. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Detlefs, Corey L can be contacted via phone (602) 521-5968.Contact Information
Primary practice address
1441 N 12Th St Fl 1
Phoenix AZ 85006-2837
Phone: (602) 521-5968
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 19043 | Arizona |
Profile Details
| NPI number | 1700842457 |
|---|---|
| LBN Legal business name | Detlefs, Corey L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 21st, 2006 |
| Last updated | Nov 20th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700842457 | NPPES |
| Arizona | MEDICAID | 140179 |
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