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General NPI Number Information
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NPI Number | 1336211101
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Entity Type | Individual
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Provider Name | MARTTI ELLIS KAHKONEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1050 GAIL GARDNER WAY STE 100
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City | PRESCOTT
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State | AZ
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Zip | 86305-1631
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Country | US
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Telephone | 928-777-0700
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Fax | 928-445-4464
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Provider Business Mailing Address
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Address Line | PO BOX 10880
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City | PRESCOTT
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State | AZ
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Zip | 86304-0880
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 35051440
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 56015
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License Number State | AZ
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