MEDICARE: DR. TIMOTHY KAVANAUGH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	4942	AK
2	207X00000X	Orthopaedic Surgery Physician	58251	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Z228811	OTHER	AZ	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053304766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY KAVANAUGH MD

Provider Business Mailing Address
First Line	:	10200 N 92ND ST STE 225
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4536
Country	:	US
Telephone Number	:	480-697-4824
Fax Number	:	480-697-4825

Provider Business Practice Location Address
First Line	:	10200 N 92ND ST STE 225
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4536
Country	:	US
Telephone Number	:	480-697-4824
Fax Number	:	480-697-4825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/21/2022

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Directions to “ DR. TIMOTHY KAVANAUGH MD” Practice Location

Language	Start Address	Practice Location

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