MEDICARE: KRISTEN VALDERHAUG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36784	AZ

General Provider Information

NPI Number	:	1104952449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN VALDERHAUG MD

Provider Business Mailing Address
First Line	:	PO BOX 15356
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85267-5356
Country	:	US
Telephone Number	:	480-485-9385
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 N DREAMY DRAW DR STE 133
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4668
Country	:	US
Telephone Number	:	602-277-2228
Fax Number	:	602-265-9494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	05/01/2023

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