MEDICARE: KEVIN W. CLEARY D.O.

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	1647	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174573000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN W. CLEARY D.O.

Provider Business Mailing Address
First Line	:	7725 N 43RD AVE
Second Line	:	STE 720
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5772
Country	:	US
Telephone Number	:	623-207-5465
Fax Number	:	623-207-5405

Provider Business Practice Location Address
First Line	:	7725 N 43RD AVE STE 720
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5772
Country	:	US
Telephone Number	:	623-207-5465
Fax Number	:	623-207-5405

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/09/2020

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