Healthcare Provider Details

I. General information

NPI: 1437259074
Provider Name (Legal Business Name): VINCENT KRASEVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 E VIA DE VENTURA STE 310
SCOTTSDALE AZ
85258-3351
US

IV. Provider business mailing address

8687 E VIA DE VENTURA STE 310
SCOTTSDALE AZ
85258-3351
US

V. Phone/Fax

Practice location:
  • Phone: 480-970-9097
  • Fax: 480-970-5318
Mailing address:
  • Phone: 480-970-9097
  • Fax: 480-970-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberIMLC.MD.61179125
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23907
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101055126
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number110132
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME143834
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG85590
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0051455
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09439100
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21087
License Number StateNV
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301095815
License Number StateMI
# 11
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036089113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: