Healthcare Provider Details

I. General information

NPI: 1427689462
Provider Name (Legal Business Name): AKOS DPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20565 N 19TH AVE
PHOENIX AZ
85027-3563
US

IV. Provider business mailing address

PO BOX 41638
PHOENIX AZ
85080-1638
US

V. Phone/Fax

Practice location:
  • Phone: 602-899-4404
  • Fax:
Mailing address:
  • Phone: 602-899-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY COZATT
Title or Position: PROJECT/RELATIONS OFFICER
Credential:
Phone: 602-899-4404