Healthcare Provider Details

I. General information

NPI: 1861996472
Provider Name (Legal Business Name): KEVIN PATRICK FOREY II MD-MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10869 N SCOTTSDALE RD # 103-915
SCOTTSDALE AZ
85254-5280
US

IV. Provider business mailing address

10869 N SCOTTSDALE RD # 103-915
SCOTTSDALE AZ
85254-5280
US

V. Phone/Fax

Practice location:
  • Phone: 480-608-5101
  • Fax: 844-528-1421
Mailing address:
  • Phone: 480-608-5101
  • Fax: 844-528-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR76681
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number59220
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: