Healthcare Provider Details

I. General information

NPI: 1891363214
Provider Name (Legal Business Name): JUSTIN ANDREW KOCEJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E MCDOWELL RD STE 200
PHOENIX AZ
85006-2608
US

IV. Provider business mailing address

1010 E MCDOWELL RD STE 206
PHOENIX AZ
85006-2608
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-1250
  • Fax: 602-956-7466
Mailing address:
  • Phone: 602-956-1250
  • Fax: 602-956-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number78228
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberBP10077014
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: