Healthcare Provider Details

I. General information

NPI: 1720128051
Provider Name (Legal Business Name): CHAD R. WESTPHAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9165 W THUNDERBIRD RD STE 200
PEORIA AZ
85381-4847
US

IV. Provider business mailing address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3870
  • Fax: 623-815-0086
Mailing address:
  • Phone: 623-876-3800
  • Fax: 623-972-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002186
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: