Individual
DR. MARK A. KALLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
645 E MISSOURI AVE STE 300, PHOENIX, AZ 85012-1351
(602) 262-8900
(602) 262-8890
Mailing address
645 E MISSOURI AVE STE 300, PHOENIX, AZ 85012-1351
(602) 262-8900
(602) 262-8890
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
19539
AZ
207L00000X
Anesthesiology Physician
MD18182
OR
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
19539
AZ
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD18182
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050039034
RR MEDICARE
OR
05
—
070040
—
OR
05
—
806093700
—
ID
05
—
8170268
—
WA
05
—
XPY183725
—
CA
Enumeration date
04/17/2006
Last updated
02/25/2021
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