Healthcare Provider Details

I. General information

NPI: 1811527732
Provider Name (Legal Business Name): LIVWELL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 E ANDERSON DR STE 104
SCOTTSDALE AZ
85255-5430
US

IV. Provider business mailing address

8541 E ANDERSON DR STE 104
SCOTTSDALE AZ
85255-5430
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-2248
  • Fax:
Mailing address:
  • Phone: 602-688-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY KAIN
Title or Position: COO
Credential:
Phone: 406-788-2298