Healthcare Provider Details

I. General information

NPI: 1689793895
Provider Name (Legal Business Name): KELVIN S CREZEE DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15810 S 45TH ST STE 190
PHOENIX AZ
85048-7697
US

IV. Provider business mailing address

15810 S 45TH ST STE 190
PHOENIX AZ
85048-7697
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: DR. KELVIN S CREZEE
Title or Position: OWNER
Credential: DPM
Phone: 480-893-1090