Kallgren, Mark A.

Kallgren, Mark A. is an individual health care provider with primary practice located at 645 E Missouri Ave Ste 300 , Phoenix AZ 85012-1351. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Kallgren, Mark A. can be contacted via phone (602) 262-8900.

Contact Information

Primary practice address
645 E Missouri Ave Ste 300 Phoenix AZ 85012-1351
Phone: (602) 262-8900
Fax: (602) 262-8890
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X MD18182 Oregon
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 19539 Arizona
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X MD18182 Oregon
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 19539 Arizona

Profile Details

NPI number 1700841541
LBN Legal business name Kallgren, Mark A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2006
Last updated Feb 25th, 2021 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700841541 NPPES
Idaho MEDICAID 806093700
Idaho Other 050039034
Idaho MEDICAID 070040
Idaho MEDICAID 8170268
Idaho MEDICAID XPY183725

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