MEDICARE: DR. KAREL A DELEEUW M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2332	ND
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	D06081	AZ
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	PT15017	ND
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	15017	ND
5	207Y00000X	Otolaryngology Physician	32072	AZ
6	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	32072	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00150696	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86080015085259C381	OTHER	AZ	TRIWEST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225013022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREL A DELEEUW M.D.

Provider Business Mailing Address
First Line	:	34522 N SCOTTSDALE RD # 404
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-1224
Country	:	US
Telephone Number	:	480-495-3356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 N 12TH ST FL 3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5977
Fax Number	:	602-521-5151

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	06/09/2025

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