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General NPI Number Information
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NPI Number | 1033270723
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Entity Type | Organization
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Legal Business Name | KENNETH O ANAEME LLC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 2600 E SOUTHERN AVE STE F2
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City | TEMPE
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State | AZ
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Zip | 85282-7626
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Country | US
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Telephone | 480-625-4704
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11773
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City | CHANDLER
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State | AZ
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Zip | 85248-0013
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Country | US
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Telephone | 480-907-7707
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Fax | 480-907-7097
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH O ANAEME
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Credential | MD
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Telephone | 602-689-5820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 30256
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 30256
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30256
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License Number State | AZ
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