Healthcare Provider Details

I. General information

NPI: 1447242888
Provider Name (Legal Business Name): KELVIN S CREZEE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

15810 S 45TH ST ST #190
PHOENIX AZ
85048-7694
US

IV. Provider business mailing address

15810 S 45TH ST SUITE # 190
PHOENIX AZ
85048-7694
US

V. Phone/Fax

Practice location:
  • Phone: 480-893-1090
  • Fax: 480-598-1458
Mailing address:
  • Phone: 480-893-1090
  • Fax: 480-598-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0328
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: