Healthcare Provider Details

I. General information

NPI: 1326900093
Provider Name (Legal Business Name): AZ ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 N 94TH DR STE C4
PEORIA AZ
85381-4841
US

IV. Provider business mailing address

PO BOX 33727
BELFAST ME
04915-0615
US

V. Phone/Fax

Practice location:
  • Phone: 480-697-4824
  • Fax:
Mailing address:
  • Phone: 480-697-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY SEAN KAVANAUGH
Title or Position: OWNER MD
Credential:
Phone: 907-351-7502