Basic Information
| Provider Information | |||||||||
| NPI: | 1295281863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KUREFUSION, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4838 E. BASELINE ROAD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812400 | ||||||||
| FaxNumber: | 4809812407 | ||||||||
| Practice Location | |||||||||
| Address1: | 4862 E. BASELINE ROAD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812404 | ||||||||
| FaxNumber: | 4809812407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | DELISIO | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | JEFFREY | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4809812400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LA0401X | 33634 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LP2900X | 33634 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.