Healthcare Provider Details

I. General information

NPI: 1174264675
Provider Name (Legal Business Name): ALPHAMED ARROWHEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20249 N 67TH AVE
GLENDALE AZ
85308-6843
US

IV. Provider business mailing address

20249 N 67TH AVE
GLENDALE AZ
85308-6843
US

V. Phone/Fax

Practice location:
  • Phone: 623-250-4550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CANTWELL
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 602-908-2025