Organization
PINETOP-LAKESIDE INTEGRATIVE & PHYSICAL MEDICINE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MAR M.D. (MANAGER)
(928) 358-1648
Entity
Organization
Contact information
Practice address
1628 REED LN, LAKESIDE, AZ 85929-6983
(928) 358-1648
(928) 368-5178
Mailing address
1628 REED LN, LAKESIDE, AZ 85929-6983
(928) 358-1648
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
34673
AZ
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
34673
AZ
Other
Enumeration date
06/13/2010
Last updated
06/13/2010
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