Healthcare Provider Details

I. General information

NPI: 1568535714
Provider Name (Legal Business Name): GARY KERSTEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 W NORTHERN AVE 108
PHOENIX AZ
85021-5472
US

IV. Provider business mailing address

1715 W NORTHERN AVE 108
PHOENIX AZ
85021-5472
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ

VIII. Authorized Official

Name: GARY KERSTEN
Title or Position: OBGYN
Credential: MD
Phone: 602-395-0718