MEDICARE: DR. KENNETH JOHN TERTEL II 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	2085R0202X	Diagnostic Radiology Physician	20863	AZ

General Provider Information

NPI Number	:	1386843605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JOHN TERTEL II M.D.

Provider Business Mailing Address
First Line	:	6890 E SUNRISE DR
Second Line	:	#120-220
City	:	TUCSON
State	:	AZ
Zip	:	85750-0738
Country	:	US
Telephone Number	:	520-547-5935
Fax Number	:	520-577-3028

Provider Business Practice Location Address
First Line	:	6270 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-5831
Country	:	US
Telephone Number	:	520-547-5935
Fax Number	:	520-541-5934

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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