Healthcare Provider Details

I. General information

NPI: 1376541516
Provider Name (Legal Business Name): KELLY LYNN ZADRAVEC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 N 73RD ST STE 295
SCOTTSDALE AZ
85255-4145
US

IV. Provider business mailing address

20401 N 73RD ST STE 295
SCOTTSDALE AZ
85255-4145
US

V. Phone/Fax

Practice location:
  • Phone: 480-538-1333
  • Fax: 480-538-1338
Mailing address:
  • Phone: 480-538-1333
  • Fax: 480-538-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number33772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: