Healthcare Provider Details

I. General information

NPI: 1154327815
Provider Name (Legal Business Name): STUART CRAIG KOZINN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

IV. Provider business mailing address

6035 E MONTECITO AVE
SCOTTSDALE AZ
85251-1943
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-1149
  • Fax: 480-994-8681
Mailing address:
  • Phone: 480-994-1149
  • Fax: 480-994-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number17569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: