Provider Demographics
NPI:1366121287
Name:KINGFISHER FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:KINGFISHER FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-250-2150
Mailing Address - Street 1:14506 W GRANITE VALLEY DR STE 123
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6012
Mailing Address - Country:US
Mailing Address - Phone:623-250-2150
Mailing Address - Fax:623-250-2450
Practice Address - Street 1:14506 W GRANITE VALLEY DR STE 123
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6012
Practice Address - Country:US
Practice Address - Phone:623-250-2150
Practice Address - Fax:623-250-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty