Healthcare Provider Details

I. General information

NPI: 1063641686
Provider Name (Legal Business Name): TODD MAXWELL DREITZLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 S RURAL RD STE 104
TEMPE AZ
85283-3717
US

IV. Provider business mailing address

18275 N 59TH AVE STE 138
GLENDALE AZ
85308-1253
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-4515
  • Fax:
Mailing address:
  • Phone: 602-564-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46628
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: