MEDICARE: KENNETH JAMES ZWIER 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	2084P0804X	Child & Adolescent Psychiatry Physician	28511	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0873180	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1326036427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JAMES ZWIER MD

Provider Business Mailing Address
First Line	:	7432 E CAMELBACK RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3509
Country	:	US
Telephone Number	:	480-423-0713
Fax Number	:	480-423-0205

Provider Business Practice Location Address
First Line	:	7432 E CAMELBACK RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3509
Country	:	US
Telephone Number	:	480-423-0713
Fax Number	:	480-423-0205

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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