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General NPI Number Information
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NPI Number | 1174573000
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Entity Type | Individual
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Provider Name | KEVIN W. CLEARY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 7725 N 43RD AVE STE 720
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City | PHOENIX
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State | AZ
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Zip | 85051-5772
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Country | US
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Telephone | 623-207-5465
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Fax | 623-207-5405
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Provider Business Mailing Address
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Address Line | 7725 N 43RD AVE STE 720
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City | PHOENIX
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State | AZ
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Zip | 85051-5772
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Country | US
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Telephone | 623-207-5465
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Fax | 623-207-5405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1647
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License Number State | AZ
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