Healthcare Provider Details

I. General information

NPI: 1225013022
Provider Name (Legal Business Name): KAREL A DELEEUW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST FL 3
PHOENIX AZ
85006-2837
US

IV. Provider business mailing address

34522 N SCOTTSDALE RD # 404
SCOTTSDALE AZ
85266-1224
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5977
  • Fax: 602-521-5151
Mailing address:
  • Phone: 480-495-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2332
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberD06081
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberPT15017
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number15017
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number32072
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number32072
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: