Healthcare Provider Details

I. General information

NPI: 1669834446
Provider Name (Legal Business Name): WILLIAM KYLE KWASS D.O., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 E ELWOOD ST STE 500
PHOENIX AZ
85040-1978
US

IV. Provider business mailing address

450 W RED RIBBON LN
ORO VALLEY AZ
85755-4797
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-1518
  • Fax: 480-304-3446
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number009015
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberS3412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: