Individual
DR. KENNETH STEPHEN BISTRICKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 E INDIAN SCHOOL RD, PHOENIX, AZ 85012-1839
(602) 277-5551
Mailing address
3391 E. CULLUMBER STREET, GILBERT, AZ 85234
(602) 277-5551
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
8807
AZ
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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