Provider Demographics
NPI:1386620821
Name:BIRKHOLZ, KARLA L (MD)
Entity type:Individual
Prefix:MS
First Name:KARLA
Middle Name:L
Last Name:BIRKHOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:B2300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1376
Practice Address - Country:US
Practice Address - Phone:623-561-9913
Practice Address - Fax:623-561-6148
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ13789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ22506OtherYOUR FAMILY PHYSICIAN PC
AZ22507Medicare ID - Type Unspecified
AZZ22506OtherYOUR FAMILY PHYSICIAN PC