Healthcare Provider Details

I. General information

NPI: 1326336843
Provider Name (Legal Business Name): CASEY RYAN SOLEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E OSBORN RD
SCOTTSDALE AZ
85251-6432
US

IV. Provider business mailing address

7400 E OSBORN RD
SCOTTSDALE AZ
85251-6432
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4809
  • Fax:
Mailing address:
  • Phone: 480-882-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number48809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: